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Sample records for acute st elevation

  1. Severe Hyperthyroidism Presenting with Acute ST Segment Elevation Myocardial Infarction

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    Dayan Zhou

    2015-01-01

    Full Text Available Introduction. Acute myocardial infarction is life-threatening. A cardiac troponin rise accompanied by typical symptoms, ST elevation or depression is diagnostic of acute myocardial infarction. Here, we report an unusual case of a female who was admitted with chest pain. However, she did not present with a typical profile of an acute myocardial infarction patient. Case Presentation. A 66-year-old Han nationality female presented with chest pain. The electrocardiogram (ECG revealed arched ST segment elevations and troponin was elevated. However, the coronary angiography showed a normal coronary arterial system. Thyroid function tests showed that this patient had severe hyperthyroidism. Conclusion. Our case highlights the possibility that hyperthyroidism may cause a large area of myocardium injury and ECG ST segment elevation. We suggest routine thyroid function testing in patients with chest pain.

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

  4. 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...... 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...... 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...

  5. Acute Carbon Monoxide Poisoning Resulting in ST Elevation Myocardial Infarction: A Rare Case Report

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    Po-Chao Hsu

    2010-05-01

    Full Text Available Acute carbon monoxide (CO poisoning with cardiac complications is well documented in the literature. However, ST segment elevation is a rare presentation, and most of these cases with ST elevation have revealed non-occlusive or normal coronary arteries. We report a case of CO poisoning complicated with ST elevation myocardial infarction. Emergency coronary angiography revealed total occlusion of the left anterior descending artery and primary percutaneous coronary intervention was performed. This report of a rare case should remind physicians that cardiovascular investigations, including electrocardiography, must be performed in cases with CO poisoning because mortality might increase if reperfusion therapy or appropriate medical treatments are not performed in patients with acute coronary artery occlusion.

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

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    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...

  7. 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...

  8. Pretreatment with prasugrel in non-ST-segment elevation acute coronary syndromes

    NARCIS (Netherlands)

    Montalescot, G.; Bolognese, L.; Dudek, D.; Goldstein, P.; Hamm, C.; Tanguay, J.F.; Berg, J.M. van den; Miller, D.L.; Costigan, T.M.; Goedicke, J.; Silvain, J.; Angioli, P.; Legutko, J.; Niethammer, M.; Motovska, Z.; Jakubowski, J.A.; Cayla, G.; Visconti, L.O.; Vicaut, E.; Widimsky, P.; Suryapranata, H.; et al.,

    2013-01-01

    BACKGROUND: Although P2Y12 antagonists are effective in patients with non-ST-segment elevation (NSTE) acute coronary syndromes, the effect of the timing of administration--before or after coronary angiography--is not known. We evaluated the effect of administering the P2Y12 antagonist prasugrel at

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

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    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. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Acute ST-Elevation Myocardial Infarction after Coronary Stent Fracture.

    Science.gov (United States)

    Rafighdust, Abbasali; Eshraghi, Ali

    2015-10-27

    The invention of the drug-eluting stent (DES) has brought about revolutionary changes in the field of interventional cardiology. In the DES era, in-stent restenosis has declined but new issues such as stent thrombosis have emerged. One of the emerging paradigms in the DES era is stent fracture. There are reports about stent fracture leading to in-stent restenosis or stent thrombosis. Most of these reports concern the Sirolimus-eluting stent. The present case is a representation of a Biolimus-eluting stent fracture. We introduce a 64-year-old male patient, for whom the BioMatrix stent was deployed in the right coronary artery. Five months after the implantation, he experienced acute myocardial infarction, with stent fracture leading to stent thrombosis being the causative mechanism. Another DES (Cypher) was used to manage this situation, and the final result was good.

  11. Cardiogenic shock with ST-segment elevation acute coronary syndrome (ReNa-Shock ST

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    Yanina Castillo Costa

    2017-08-01

    Full Text Available Cardiogenic shock (CS in the setting of an ST-segment elevation myocardial infarction (STEMI is a severe complication and constitutes one of the principal causes of death associated with this condition. The aim of this study was to describe the clinical characteristics, treatment strategies and hospital outcome of CS associated with STEMI in Argentina. The Argentine Registry of Cardiogenic Shock (ReNA-Shock was a prospective and multicenter registry of consecutive patients with CS hospitalized in 64 centers in Argentina between July 2013 and May 2015. Only those with ST-segment elevation myocardial infarction (STEMI were selected for this analysis. Of the 165 patients included in the ReNa-Shock registry, 124 presented STEMI. Median age was 64 years (IQR 25-75: 56.5-75 and 67% were men; median time from symptom onset to admission was 240 minutes (IQR 25-75: 132-720. 63% of the cases presented CS at admission. Eighty-seven percent underwent reperfusion therapy: 80% primary percutaneous intervention with a median door-to-balloon time of 110 minutes (IQR 25-75: 62-184. Inotropic agents were used in 96%; 79% required mechanical ventilation; a Swan Ganz catheter was inserted in 47% and 35% required intra-aortic balloon pumping. Most patients (59% presented multivessel disease (MV. Hospital mortality was 54%. Multivariate analysis identified that time from symptom onset to admission (> 240 min was the only independent predictor of mortality (OR: 3.04; CI 95%: 1.18-7.9. Despite using treatment strategies currently available, morbidity and mortality of STEMI complicated with CS remains high.

  12. Frequency of left ventricular thrombus after anterior wall st-segment elevation acute myocardial infarction

    International Nuclear Information System (INIS)

    Iqbal, M.W.; Fayyaz, A.

    2014-01-01

    Left ventricular thrombus (LVT) formation is a well known complication seen in patients presenting with acute anterior wall ST-segment elevation myocardial infarction (STEMI). In previous studies the incidence of this complication, after acute myocardial infarction (AMI) has been reported to be 4% to 60% in large anterior wall STEMI, depending significantly upon the method as well as time of reperfusion therapy after STEMI. Objective: The objective of this descriptive case series study was to evaluate the frequency of left ventricular thrombus formation in patients after acute anterior wall ST-Segment elevation myocardial infarction. Methodology: In this study, 100 patients with anterior wall STEMI presenting to cardiac emergency or coronary care unit (CCU) of Cardiac complex, Gulab Devi Hospital, were selected on non-probability, purposive sampling meeting inclusion criteria, after taking written informed consent. All the patients were treated initially for management of acute STEMI, including use of thrombolytics where indicated. 2-D Transthoracic echocardiography (TTE) was performed during the same admission to assess presence of LV thrombus (LVT). Results: The mean age of the patients was 54.3 +- 11.4 years. There were 84(84%) male patients and 16 (16%) female patients. LVT was present in 28 (28%) patients on TTE. Among those, there were 23 (82.1%) male and 5 (17.9%) female patients. However, out of 84 male patients 27.4% develop LVT and among 16 female patients this ratio was 31.3%. The LV thrombus was independent of age and gender. LV thrombus was significantly less in thrombolytic group as compared to those who were not given this therapy, i.e. p value <0.05. Conclusion: Patients with anterior wall acute STEMI not infrequently develop the complication of development of LV thrombus. In this study the frequency of LV thrombus formation after anterior wall acute STEMI was 28%. (author)

  13. Acute ST-Elevation Myocardial Infarction, a Unique Complication of Recreational Nitrous Oxide Use.

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    Indraratna, Praveen; Alexopoulos, Chris; Celermajer, David; Alford, Kevin

    2017-08-01

    A 28-year-old male was admitted to hospital with an acute ST-elevation myocardial infarction. This was in the context of recreational abuse of nitrous oxide. The prevalence of nitrous oxide use in Australia has not been formally quantified, however it is the second most commonly used recreational drug in the United Kingdom. Nitrous oxide has previously been shown to increase serum homocysteine levels. This patient was discovered to have an elevated homocysteine level at baseline, which was further increased after nitrous oxide consumption. Homocysteine has been linked to endothelial dysfunction and coronary atherosclerosis and this case report highlights one of the dangers of recreational abuse of nitrous oxide. Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  14. Early Invasive Versus Selective Strategy for Non-ST-Segment Elevation Acute Coronary Syndrome: The ICTUS Trial

    NARCIS (Netherlands)

    Hoedemaker, N.P.G.; Damman, P.; Woudstra, P.; Hirsch, A.; Windhausen, F.; Tijssen, J.G.; Winter, R.J. de; Verheugt, F.W.A.; et al.,

    2017-01-01

    BACKGROUND: The ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes) trial compared early invasive strategy with a selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and an elevated cardiac troponin T. No long-term

  15. Early Invasive Versus Selective Strategy for Non-ST-Segment Elevation Acute Coronary Syndrome: The ICTUS Trial

    NARCIS (Netherlands)

    Hoedemaker, Niels P. G.; Damman, Peter; Woudstra, Pier; Hirsch, Alexander; Windhausen, Fons; Tijssen, Jan G. P.; de Winter, Robbert J.; Peters, R. J. G.; Dunselman, P. H. J. M.; Verheugt, F. W. A.; Janus, C. L.; Umans, V.; Bendermacher, P. E. F.; Michels, H. R.; Sadé e, A.; Hertzberger, D.; de Miliano, P. A. R. M.; Liem, A. H.; Tjon Joe Gin, R.; van der Linde, M.; Lok, D.; Hoedemaker, G.; Pieterse, M.; van den Merkhof, L.; Danië ls, M.; van Hessen, M.; Hermans, W.; Schotborgh, C. E.; de Zwaan, C.; Bredero, A.; de Jaegere, P.; Janssen, M.; Louwerenburg, J.; Veerhoek, M.; Schalij, M.; de Porto, A.; Zijlstra, F.; Winter, J.; de Feyter, P.; Robles de Medina, R.; Withagen, P.; Sedney, M.; Thijssen, H.; van Rees, C.; van den Bergh, P.; de Cock, C.; van 't Hof, A.; Suttorp, M. J.; Windhausen, F.; Cornel, J. H.

    2017-01-01

    The ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes) trial compared early invasive strategy with a selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and an elevated cardiac troponin T. No long-term benefit of an

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

    NARCIS (Netherlands)

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

    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.

  17. [Treatment and management after acute coronary syndrome without ST-elevation].

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    Drogoul, Laurent; Scarlatti, Didier; Ferrari, Emile

    2010-03-01

    Coronary syndromes without ST elevation, previously known as unstable angina, are now more frequent than ST elevation myocardial infarction. Evidence-based studies should guide their management after hospital discharge. This management seeks to fulfill precise objectives and has been demonstrated to be effective in terms of survival. Copyright (c) 2009 Elsevier Masson SAS. All rights reserved.

  18. Prognostic implications of stress hyperglycemia in acute ST elevation myocardial infarction. Prospective observational study.

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    Sanjuán, Rafael; Núñez, Julio; Blasco, M Luisa; Miñana, Gema; Martínez-Maicas, Helena; Carbonell, Nieves; Palau, Patricia; Bodí, Vicente; Sanchis, Juan

    2011-03-01

    In patients with acute myocardial infarction, elevation of plasma glucose levels is associated with worse outcomes. The aim of this study was to evaluate the association between stress hyperglycemia and in-hospital mortality in patients with acute myocardial infarction with ST-segment elevation (STEMI). We analyzed 834 consecutive patients admitted for STEMI to the Coronary Care Unit of our center. Association between admission glucose and mortality was assessed with Cox regression analysis. Discriminative accuracy of the multivariate model was assessed by Harrell's C statistic. Eighty-nine (10.7%) patients died during hospitalization. Optimal threshold glycemia level of 140mg/dl on admission to predict mortality was obtained by ROC curves. Those who presented glucose ≥140mg/dl showed higher rates of malignant ventricular tachyarrhythmias (28% vs. 18%, P=.001), complicative bundle branch block (5% vs. 2%, P=.005), new atrioventricular block (9% vs. 5%, P=.05) and in-hospital mortality (15% vs. 5%, PStress hyperglycemia on admission is a predictor of mortality and arrhythmias in patients with STEMI and could be used in the stratification of risk in these patients. Copyright © 2010 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  19. 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...... +/- 11% (p = 0.0001). All episodes of ST-segment elevation were asymptomatic and did not correlate with different indicators of myocardial ischemia. Indeed, exercise-induced ST-segment depression was more prevalent in group 2 than in group 1: 57 vs 18% (p

  20. 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

    Newly produced platelets are present in the acute phase of ST-elevation myocardial infarction (STEMI). This may influence the antiplatelet effect of aspirin and clopidogrel administered prior to primary percutaneous coronary intervention (PPCI). The aims of this study were to investigate the anti...... turnover may partly explain the reduced efficacy of antiplatelet drugs in the acute phase of STEMI....... 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...... in the ambulance. Blood samples were obtained immediately prior to PPCI, at 4 and 12 hours after administration of bolus doses and at follow-up after 3 months. Residual platelet aggregation was evaluated by Multiplate® and VerifyNow® aggregometry. Platelet turnover was evaluated by automated flow cytometry...

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

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    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.

  2. ST-Segment Elevated Acute Myocardial Infarction: Changing Profile Over Last 24 Years.

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    Mishra, Trinath Kumar; Das, Biswajit

    2016-06-01

    Coronary artery disease (CAD) is rising in epidemic proportions with India not being an exception. CAD in Indian scenario has its onset at a younger age with multitude of risk factors. This study was carried out to obtain complete information about demographic profile, risk factors, clinical scenario, therapeutic modalities, natural course, outcome and changing profile of acute ST-segment elevated myocardial infarction (STEMI) patients. This cross-sectional study was conducted in 45,122 acute STEMI patients admitted 1st March 1990 to 1st March 2014. A predefined performa was completed in every patient with detailed clinical history, physical examination, laboratory and investigation parameters, therapeutic interventions and inhospital outcome. Our population cohort presented with STEMI at age of 56.34±11.88 years with 82.48% male. Urban residency (64.35%), lower level of education (61.03%), middle and low socioeconomic status (81.01%), unemployment (56.47%), lack of exercise (78.80%) and poor dietary pattern including low intake of fruits and vegetables (58.80%) were pivotal players. Smoking was prevalent in 48.80% cases, with overweight and obesity (51.11%), diabetes mellitus (27.34%), hypertension (38.85%), hyperlipidemia (28.15%), alcoholism (28.80%) and family history (16.66%). Our population had mildly elevated LDL (101.4±33.38 mg/dl), low HDL (36.6±10.7 mg.dl) and high TC/HDL ratio (4.05±1.36). Majority harbored (52.06%) two or more risk factors, while in 16.60% no conventional risk factors were identified. Anterior wall STEMI (56.78%) far exceeded the inferior wall (37.55%). Less than half (47.77%) presented within the window period of 12 hours while only 0.8% of patients availed the golden period of 1 hour. 50.27% presented in Killip Class II or beyond. Angiography revealed single vessel disease (46.76%) with LAD involvement being most common (58.85%). Thrombolytic therapy was provided in 38.95% and primary PCI in 2.1%. Complications in the form of CHF

  3. Adherence to cardiac practice guidelines in the management of Non-ST-Elevation Acute Coronary Syndromes: a systematic literature review.

    NARCIS (Netherlands)

    Engel, J.; Damen, N.L.; Wulp, I. van der; Bruijne, M.C. de; Wagner, C.

    2017-01-01

    Background: In the management of non-ST-elevation acute coronary syndrome (NSTACS) a gap between guideline-recommended care and actual practice has been reported. A systematic overview of the actual extent of this gap, its potential impact on patient-outcomes, and influential factors is lacking.

  4. Invasive strategies and outcomes for non-ST-segment elevation acute coronary syndromes: a twelve-year experience from SWEDEHEART

    NARCIS (Netherlands)

    Damman, Peter; Jernberg, Tomas; Lindahl, Bertil; de Winter, Robbert J.; Jeppsson, Anders; Johanson, Per; Held, Claes; James, Stefan K.

    2016-01-01

    Despite recommendations in recent guidelines for a routine invasive strategy for non-ST-segment elevation acute coronary syndrome (NSTE-ACS), long-term data on the implementation of treatment strategies in clinical practice are not available. Our aim was to provide long-term data on the

  5. Prognostic value of dynamic electrocardiographic T wave changes in non-ST elevation acute coronary syndrome.

    Science.gov (United States)

    Sarak, Bradley; Goodman, Shaun G; Yan, Raymond T; Tan, Mary K; Steg, Ph Gabriel; Tan, Nigel S; Fox, Keith A A; Udell, Jacob A; Brieger, David; Welsh, Robert C; Gale, Chris P; Yan, Andrew T

    2016-09-01

    To assess the relationship between the evolution of T wave inversion (TWI) on the 24-48 h postadmission ECG and the patient characteristics, management and clinical outcomes among those with non-ST elevation acute coronary syndrome (NSTE-ACS). We evaluated admission and 24-48 h follow-up ECGs of 7201 patients with NSTE-ACS from the prospective, multicentre Global Registry of Acute Coronary Events (GRACE) and Canadian ACS Registry I. We performed multivariable analyses to determine the association between new TWI (on follow-up ECG only), resolved TWI (on admission ECG only) and persistent TWI (on both admission and follow-up ECG) and inhospital and cumulative 6-month all-cause mortality. Patients with TWI were older, more likely to have cardiovascular risk factors, higher Killip class and GRACE risk scores. After adjustment for known prognostic factors, compared with patients presenting without TWI, new TWI was associated with significantly lower inhospital mortality (OR=0.60, 95% CI 0.38 to 0.95, p=0.029), whereas resolved (OR=1.06, 95% CI 0.65 to 1.75, p=0.81) and persistent (OR=0.73, 95% CI 0.48 to 1.11, p=0.14) TWI did not predict inhospital mortality. No TWI pattern independently predicted inhospital adverse cardiovascular events or cumulative 6-month mortality. In contrast, ST depression on the admission and follow-up ECG were independent predictors of inhospital and 6-month mortality. Across the spectrum of NSTE-ACS, TWI within 48 h of presentation was associated with high-risk clinical features, but its presence or dynamic change did not provide additional prognostic value beyond other established clinical predictors. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  6. PREVENTION OF LEFT VENTRICLE SYSTOLIC DYSFUNCTION IN PATIENTS WITH ACUTE CORONARY SYNDROME WITH ST SEGMENT ELEVATION AFTER CARDIAC REVASCULARIZATION

    OpenAIRE

    A. L. Alyavi; B. A. Alyavi; M. L. Kenzhaev; S. R. Kenzhaev

    2009-01-01

    Aim. To study effects of bioflavonoid quercetin (corvitin) on left ventricle (LV) systolic dysfunction in patients with acute coronary syndrome with ST segment elevation (ACS+ST) after cardiac revascularization.Material and methods. 60 patients with ACS+ST (44,2±1,3 y.o.) were examined. Patients were admitted to hospital within 6 hours after complaints beginning. Patients were randomized in two groups. 30 patients of group A had standard therapy and cardiac revascularization. 30 patients of g...

  7. [Early invasive strategy in diabetic patients with non-ST-segment elevation acute coronary syndromes].

    Science.gov (United States)

    Baeza Román, Anna; Latour Pérez, Jaime; de Miguel Balsa, Eva; Pino Izquierdo, Karel; Coves Orts, Francisco Javier; García Ochando, Luis; de la Torre Fernández, Maria José

    2014-05-20

    In the management of non-ST-segment elevation acute coronary syndromes (NSTE-ACS), several studies have shown a reduction in mortality with the use of an invasive strategy in high-risk patients, including diabetic patients. Paradoxically, other studies have shown an under-utilization of this invasive strategy in these patients. The aim of this study is to determine the characteristics of patients managed conservatively and identify determinants of the use of invasive or conservative strategy. Retrospective cohort study conducted in diabetic patients with NSTE-ACS included in the ARIAM-SEMICYUC registry (n=531) in 2010 and 2011. We performed crude and adjusted unconditional logistic regression. We analyzed 531 diabetic patients, 264 (49.7%) of which received invasive strategy. Patients managed conservatively were a subgroup characterized by older age and cardiovascular comorbidity, increased risk of bleeding and the absence of high-risk electrocardiogram (ECG). In diabetic patients with NSTE-ACS, independent predictors associated with conservative strategy were low-risk ECG, initial Killip class>1, high risk of bleeding and pretreatment with clopidogrel. The fear of bleeding complications or advanced coronary lesions could be the cause of the underutilization of an invasive strategy in diabetic patients with NSTE-ACS. Copyright © 2012 Elsevier España, S.L. All rights reserved.

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

    International Nuclear Information System (INIS)

    Castillo Costa, Yanina; Mauro, Victor; Perez, Roberto; Charask, Adrian; Fairman, Enrique; Gomez Santamaria, Hector; Goral, Jorge; Barrero, Carlos

    2009-01-01

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

  9. Do stable non-ST-segment elevation acute coronary syndromes require admission to coronary care units?

    Science.gov (United States)

    van Diepen, Sean; Lin, Meng; Bakal, Jeffrey A; McAlister, Finlay A; Kaul, Padma; Katz, Jason N; Fordyce, Christopher B; Southern, Danielle A; Graham, Michelle M; Wilton, Stephen B; Newby, L Kristin; Granger, Christopher B; Ezekowitz, Justin A

    2016-05-01

    Clinical practice guidelines recommend admitting patients with stable non-ST-segment elevation acute coronary syndrome (NSTE ACS) to telemetry units, yet up to two-thirds of patients are admitted to higher-acuity critical care units (CCUs). The outcomes of patients with stable NSTE ACS initially admitted to a CCU vs a cardiology ward with telemetry have not been described. We used population-based data of 7,869 patients hospitalized with NSTE ACS admitted to hospitals in Alberta, Canada, between April 1, 2007, and March 31, 2013. We compared outcomes among patients initially admitted to a CCU (n=5,141) with those admitted to cardiology telemetry wards (n=2,728). Patients admitted to cardiology telemetry wards were older (median 69 vs 65years, PST-segment myocardial infarction or unstable angina. There were no differences in clinical outcomes observed between patients with NSTE ACS initially admitted to a ward or a CCU. These findings suggest that stable NSTE ACS may be managed appropriately on telemetry wards and presents an opportunity to reduce hospital costs and critical care capacity strain. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. 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...

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

    Science.gov (United States)

    Carrick, David; Haig, Caroline; Carberry, Jaclyn; McCartney, Peter; Welsh, Paul; Ahmed, Nadeem; McEntegart, Margaret; Petrie, Mark C.; Eteiba, Hany; Lindsay, Mitchell; Hood, Stuart; Watkins, Stuart; Rauhalammi, Samuli M.O.; Mordi, Ify; Ford, Ian; Radjenovic, Aleksandra; Sattar, Naveed; Oldroyd, Keith G.

    2016-01-01

    BACKGROUND. Failed myocardial reperfusion is common and prognostically important after acute ST-elevation myocardial infarction (STEMI). The purpose of this study was to investigate coronary flow reserve (CFR), a measure of vasodilator capacity, and the index of microvascular resistance (IMR; mmHg × s) in the culprit artery of STEMI survivors. METHODS. IMR (n = 288) and CFR (n = 283; mean age [SD], 60 [12] years) were measured acutely using guide wire–based thermodilution. Cardiac MRI disclosed left ventricular pathology, function, and volumes at 2 days (n = 281) and 6 months after STEMI (n = 264). All-cause death or first heart failure hospitalization was independently adjudicated (median follow-up 845 days). RESULTS. Myocardial hemorrhage and microvascular obstruction occurred in 89 (42%) and 114 (54%) patients with evaluable T2*-MRI maps. IMR and CFR were associated with microvascular pathology (none vs. microvascular obstruction only vs. microvascular obstruction and myocardial hemorrhage) (median [interquartile range], IMR: 17 [12.0–33.0] vs. 17 [13.0–39.0] vs. 37 [21.0–63.0], P < 0.001; CFR: 1.7 [1.4–2.5] vs. 1.5 [1.1–1.8] vs. 1.4 [1.0–1.8], P < 0.001), whereas thrombolysis in myocardial infarction blush grade was not. IMR was a multivariable associate of changes in left ventricular end-diastolic volume (regression coefficient [95% CI] 0.13 [0.01, 0.24]; P = 0.036), whereas CFR was not (P = 0.160). IMR (5 units) was a multivariable associate of all-cause death or heart failure hospitalization (n = 30 events; hazard ratio [95% CI], 1.09 [1.04, 1.14]; P < 0.001), whereas CFR (P = 0.124) and thrombolysis in myocardial infarction blush grade (P = 0.613) were not. IMR had similar prognostic value for these outcomes as <50% ST-segment resolution on the ECG. CONCLUSIONS. IMR is more closely associated with microvascular pathology, left ventricular remodeling, and health outcomes than the angiogram or CFR. TRIAL REGISTRATION. NCT02072850. FUNDING. A

  12. 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...

  13. The Effects of Niacin on Inflammation in Patients with Non-ST Elevated Acute Coronary Syndrome

    Science.gov (United States)

    Karacaglar, Emir; Atar, Ilyas; Altin, Cihan; Yetis, Begum; Cakmak, Abdulkadir; Bayraktar, Nilufer; Coner, Ali; Ozin, Bulent; Muderrisoglu, Haldun

    2015-01-01

    Background In this study, we aimed to evaluate the effects of niacin on high sensitivity C reactive protein (hs-CRP) and cholesterol levels in non-ST elevated acute coronary syndrome (NSTE-ACS) patients. Methods In this prospective, open label study, 48 NSTE-ACS were randomized to niacin or control group. Patients continued their optimal medical therapy in the control group. In the niacin group patients were assigned to receive extended-release niacin 500 mg/day. Patients were contacted 1 month later to assess compliance and side effects. Blood samples for hs-CRP were obtained upon admittance to the coronary care unit, in the third day and in the first month of the treatment. Fasting blood samples for cholesterol levels were obtained before and 30 days after the treatment. The primary end point of the study was to evaluate changes in hs-CRP, cholesterol levels, short-term cardiovascular events, and the safety of niacin in NSTE-ACS. Results Baseline demographic, clinical and laboratory characteristics were similar between the two groups. Logarithmic transformation of baseline and 3rd day hs-CRP levels were similar between the groups; but 1 month later, logarithmic transformation of hs-CRP level was significantly lower in the niacin group (0.43 ± 0.39 to 0.83 ± 0.91, p = 0.04). HDL-C level was significantly increased in the niacin group during follow-up. Drug related side effects were seen in 7 patients in the niacin group but no patients discontinued niacin. Conclusions Our findings demonstrate that lower dose extended release niacin can be used safely and decreases hs-CRP and lipid parameters successfully in NSTE-ACS patients. PMID:27122858

  14. 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.

  15. Survival after hospital discharge for ST-segment elevation and non-ST-segment elevation acute myocardial infarction: a population-based study

    Directory of Open Access Journals (Sweden)

    Darling CE

    2013-07-01

    Full Text Available Chad E Darling,1 Kimberly A Fisher,2 David D McManus,3,4 Andrew H Coles,5 Frederick A Spencer,5,6 Joel M Gore,3,4 Robert J Goldberg31Department of Emergency Medicine, 2Division of Pulmonary Critical Care, 3Department of Quantitative Health Sciences, 4Department of Medicine, 5Program for Gene Function and Expression, University of Massachusetts Medical School, Worcester, MA, USA; 6Department of Medicine, McMaster University, Hamilton, Ontario, CanadaBackground: Limited recent data are available describing differences in long-term survival, and factors affecting prognosis, after ST-segment elevation myocardial infarction (STEMI and non-ST-segment elevation myocardial infarction (NSTEMI, especially from the more generalizable perspective of a population-based investigation. The objectives of this study were to examine differences in post-discharge prognosis after hospitalization for STEMI and NSTEMI, with a particular focus on factors associated with reduced long-term survival.Methods: We reviewed the medical records of residents of the Worcester, MA, USA metropolitan area hospitalized at eleven central Massachusetts medical centers for acute myocardial infarction (AMI during 2001, 2003, 2005, and 2007.Results: A total of 3762 persons were hospitalized with confirmed AMI; of these, 2539 patients (67.5% were diagnosed with NSTEMI. The average age of study patients was 70.3 years and 42.9% were women. Patients with NSTEMI experienced higher post-discharge death rates with 3-month, 1-year, and 2-year death rates of 12.6%, 23.5%, and 33.2%, respectively, compared to 6.1%, 11.5%, and 16.4% for patients with STEMI. After multivariable adjustment, patients with NSTEMI were significantly more likely to have died after hospital discharge (adjusted hazards ratio 1.28; 95% confidence interval 1.14–1.44. Several demographic (eg, older age and clinical (eg, history of stroke factors were associated with reduced long-term survival in patients with NSTEMI and

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

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    Viola William Keddeas

    2017-06-01

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

  17. Platelet Glycoprotein IIb/IIIa Receptor Inhibition in Non-ST-Elevation Acute Coronary Syndromes : Early Benefit During Medical Treatment Only, With Additional Protection During Percutaneous Coronary Intervention

    NARCIS (Netherlands)

    K.M. Akkerhuis (Martijn); P. Théroux (Pierre); R.M. Califf (Robert); E.J. Topol (Eric); M.L. Simoons (Maarten); H. Boersma (Eric)

    1999-01-01

    textabstractBACKGROUND: Glycoprotein (GP) IIb/IIIa receptor blockers prevent life-threatening cardiac complications in patients with acute coronary syndromes without ST-segment elevation and protect against thrombotic complications associated with percutaneous coronary

  18. 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

  19. Outcomes of Patients Presenting With Clinical Indices of Spontaneous Reperfusion in ST-Elevation Acute Coronary Syndrome Undergoing Deferred Angiography.

    Science.gov (United States)

    Fefer, Paul; Beigel, Roy; Atar, Shaul; Aronson, Doron; Pollak, Arthur; Zahger, Doron; Asher, Elad; Iakobishvili, Zaza; Shlomo, Nir; Alcalai, Ronny; Einhorn-Cohen, Michal; Segev, Amit; Goldenberg, Ilan; Matetzky, Shlomi

    2017-07-25

    Few data are available regarding the optimal management of ST-elevation myocardial infarction patients with clinically defined spontaneous reperfusion (SR). We report on the characteristics and outcomes of patients with SR in the primary percutaneous coronary intervention era, and assess whether immediate reperfusion can be deferred. Data were drawn from a prospective nationwide survey, ACSIS (Acute Coronary Syndrome Israeli Survey). Definition of SR was predefined as both (1) ≥70% reduction in ST-segment elevation on consecutive ECGs and (2) ≥70% resolution of pain. Of 2361 consecutive ST-elevation-acute coronary syndrome patients in Killip class 1, 405 (17%) were not treated with primary reperfusion therapy because of SR. Intervention in SR patients was performed a median of 26 hours after admission. These patients were compared with the 1956 ST-elevation myocardial infarction patients who underwent primary reperfusion with a median door-to-balloon of 66 minutes (interquartile range 38-106). Baseline characteristics were similar except for slightly higher incidence of renal dysfunction and prior angina pectoris in SR patients. Time from symptom onset to medical contact was significantly greater in SR patients. Patients with SR had significantly less in-hospital heart failure (4% versus 11%) and cardiogenic shock (0% versus 2%) ( P <0.01 for all). No significant differences were found in in-hospital mortality (1% versus 2%), 30-day major cardiac events (4% versus 4%), and mortality at 30 days (1% versus 2%) and 1 year (4% versus 4%). Patients with clinically defined SR have a favorable prognosis. Deferring immediate intervention seems to be safe in patients with clinical indices of spontaneous reperfusion. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  20. Cystatin C: a novel predictor of outcome in suspected or confirmed non-ST-elevation acute coronary syndrome.

    Science.gov (United States)

    Jernberg, Tomas; Lindahl, Bertil; James, Stefan; Larsson, Anders; Hansson, Lars-Olof; Wallentin, Lars

    2004-10-19

    Patients with suspected or confirmed non-ST-elevation acute coronary syndrome (ACS) constitute a large and heterogeneous group. Measurements of renal function such as serum creatinine and estimation of creatinine clearance carry independent prognostic information in this population. Cystatin C is a new and better marker of renal function than creatinine. The aim was therefore to evaluate the prognostic value of cystatin C in this population. Cystatin C was analyzed on admission in 726 patients admitted because of symptoms suggestive of an acute coronary syndrome and no ST-segment elevations. Patients were followed up with regard to death and myocardial infarction for a median of 40 and 6 months, respectively. The median cystatin C level was 1.00 mg/L (25th to 75th percentile, 0.83 to 1.24 mg/L). The risk of death during follow-up increased with increasing levels of cystatin C. In the group with non-ST-elevation ACS, patients in the second, third, and fourth quartiles had a relative risk of subsequent death of 1.8 (95% CI, 0.6 to 5.3), 3.2 (95% CI, 1.2 to 8.5), and 11.7 (95% CI, 4.7 to 29.3) compared with the lowest quartile. In Cox regression models including well-known predictors of outcome, cystatin C level was independently associated with mortality but not with the risk of subsequent myocardial infarction. In a comparison of the markers of renal function in receiver-operating curve analyses, cystatin C had the best ability to discriminate between survivors and nonsurvivors. A single measurement of cystatin C will substantially improve the early risk stratification of patients with suspected or confirmed non-ST-elevation ACS.

  1. Myocardial Hemorrhage After Acute Reperfused ST-Segment–Elevation Myocardial Infarction

    Science.gov (United States)

    Carrick, David; Haig, Caroline; Ahmed, Nadeem; McEntegart, Margaret; Petrie, Mark C.; Eteiba, Hany; Hood, Stuart; Watkins, Stuart; Lindsay, M. Mitchell; Davie, Andrew; Mahrous, Ahmed; Mordi, Ify; Rauhalammi, Samuli; Sattar, Naveed; Welsh, Paul; Radjenovic, Aleksandra; Ford, Ian; Oldroyd, Keith G.

    2016-01-01

    Background— The success of coronary reperfusion therapy in ST-segment–elevation myocardial infarction (MI) is commonly limited by failure to restore microvascular perfusion. Methods and Results— We performed a prospective cohort study in patients with reperfused ST-segment–elevation MI who underwent cardiac magnetic resonance 2 days (n=286) and 6 months (n=228) post MI. A serial imaging time-course study was also performed (n=30 participants; 4 cardiac magnetic resonance scans): 4 to 12 hours, 2 days, 10 days, and 7 months post reperfusion. Myocardial hemorrhage was taken to represent a hypointense infarct core with a T2* value of hemorrhage 2 days post MI was associated with clinical characteristics indicative of MI severity and inflammation. Myocardial hemorrhage was a multivariable associate of adverse remodeling (odds ratio [95% confidence interval]: 2.64 [1.07–6.49]; P=0.035). Ten (4%) patients had a cardiovascular cause of death or experienced a heart failure event post discharge, and myocardial hemorrhage, but not microvascular obstruction, was associated with this composite adverse outcome (hazard ratio, 5.89; 95% confidence interval, 1.25–27.74; P=0.025), including after adjustment for baseline left ventricular end-diastolic volume. In the serial imaging time-course study, myocardial hemorrhage occurred in 7 (23%), 13 (43%), 11 (33%), and 4 (13%) patients 4 to 12 hours, 2 days, 10 days, and 7 months post reperfusion. The amount of hemorrhage (median [interquartile range], 7.0 [4.9–7.5]; % left ventricular mass) peaked on day 2 (Phemorrhage and microvascular obstruction follow distinct time courses post ST-segment–elevation MI. Myocardial hemorrhage was more closely associated with adverse outcomes than microvascular obstruction. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT02072850. PMID:26763281

  2. 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

  3. 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.

  4. Results of the Croatian Primary Percutaneous Coronary Intervention Network for patients with ST-segment elevation acute myocardial infarction.

    Science.gov (United States)

    Nikolić Heitzler, Vjeran; Babic, Zdravko; Milicic, Davor; Bergovec, Mijo; Raguz, Miroslav; Mirat, Jure; Strozzi, Maja; Plazonic, Zeljko; Giunio, Lovel; Steiner, Robert; Starcevic, Boris; Vukovic, Ivica

    2010-05-01

    The Republic of Croatia, with a gross domestic product per capita of US$11,554 in 2008, is an economically less-developed Western country. The goal of the present investigation was to prove that a well-organized primary percutaneous coronary intervention network in an economically less-developed country equalizes the prospects of all patients with acute ST-segment elevation myocardial infarction at a level comparable to that of more economically developed countries. We prospectively investigated 1,190 patients with acute ST-segment elevation myocardial infarction treated with primary PCI in 8 centers across Croatia (677 nontransferred and 513 transferred). The postprocedural Thrombolysis In Myocardial Infarction flow, in-hospital mortality, and incidence of major adverse cardiovascular events (ie, mortality, pectoral angina, restenosis, reinfarction, coronary artery bypass graft, and cerebrovascular accident rate) during 6 months of follow-up were compared between the nontransferred and transferred subgroups and in the subgroups of older patients, women, and those with cardiogenic shock. In all investigated patients, the average door-to-balloon time was 108 minutes, and the total ischemic time was 265 minutes. Postprocedural Thrombolysis In Myocardial Infarction 3 flow was established in 87.1% of the patients, and the in-hospital mortality rate was 4.4%. No statistically significant difference was found in the results of treatment between the transferred and nontransferred patients overall or in the subgroups of patients >75 years, women, and those with cardiogenic shock. In conclusion, the Croatian Primary Percutaneous Coronary Intervention Network has ensured treatment results of acute ST-segment elevation myocardial infarction comparable to those of randomized studies and registries of more economically developed countries. Copyright 2010 Elsevier Inc. All rights reserved.

  5. ST-segment Elevation Acute Myocardial Infarction in a Patient with Acromegaly: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Ming-Ying Lu

    2006-06-01

    Full Text Available Acromegaly is a disorder caused by the excess production of pituitary growth hormone and is characterized by the enlargement of the hands, feet and head. Increased morbidity and mortality with acromegaly is associated with cardiovascular complications, hypertension, glucose intolerance, cardiomyopathy and coronary artery disease. We report a case of acromegaly, which presented with ST-segment elevation acute myocardial infarction. The patient received successful primary transluminal coronary angioplasty with stent implantation. Acromegaly was suspected from typical appearance, and confirmed with hormonal examination and imaging of the pituitary mass. We discuss this case in comparison with previous literature.

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

    NARCIS (Netherlands)

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

    2007-01-01

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

  7. EARLY PREDICTORS OF 30-DAY MORTALITY INNON-ST-ELEVATION ACUTE CORONARY SYNDROME PATIENTS

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    Suzana Rožič

    2008-09-01

    30-day mortality was 4.3 %. Between nonsurvivors and survivors there were significantdifferences in mean age, the incidence of arterial hypertension, positive family history ofcoronary artery disease, in mean admission systolic and diastolic blood pressure, pulse,mean admission troponin T, leukocyte count, CRP, creatinine and the incidence of admission heart failure. Multivariate logistic regression proved that most significant independent early predictor of 30-day mortality was admission heart failure (OR 41.21, 95 %CI 3.50 to 484.66, p = 0.003, followed by admission serum creatinine (OR 0.989, 95 %CI 0.981 to 0.997, p = 0.008 and troponin T (OR 0.263, 95 % CI 0.080 to 0.861.Conclusion Most significant independent predictor of 30-day mortality of patients with non-ST-elevation ACS, being 4.5 %, was heart failure on admission

  8. Acute ST Segment Elevation Myocardial Infarction and Massive Pericardial Effusion Due to Infective Endocarditis

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    Maxwell Thompson

    2017-03-01

    Full Text Available Chest pain is a common complaint evaluated in the emergency department. While chest pain in a 22-year-old patient is typically a complaint of low acuity, high-acuity cases that rival those of the older patient population are well documented. We describe a case of complicated infective endocarditis in which point-of-care ultrasound (POCUS aided the diagnosis of ST-elevation myocardial infarction secondary to a septic thrombus in a 22-year-old female with a history of intravenous drug use. Emergency physicians should be aware of the rare high-acuity cases as well as the impact of POCUS on rapid clinical assessment and treatment of patients of all ages presenting with chest pain.

  9. PREVENTION OF LEFT VENTRICLE SYSTOLIC DYSFUNCTION IN PATIENTS WITH ACUTE CORONARY SYNDROME WITH ST SEGMENT ELEVATION AFTER CARDIAC REVASCULARIZATION

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    A. L. Alyavi

    2016-01-01

    Full Text Available Aim. To study effects of bioflavonoid quercetin (corvitin on left ventricle (LV systolic dysfunction in patients with acute coronary syndrome with ST segment elevation (ACS+ST after cardiac revascularization.Material and methods. 60 patients with ACS+ST (44,2±1,3 y.o. were examined. Patients were admitted to hospital within 6 hours after complaints beginning. Patients were randomized in two groups. 30 patients of group A had standard therapy and cardiac revascularization. 30 patients of group B received corvitin additionally to standard therapy before cardiac revascularization. Echocardiography initially and stress-echocardiography with dobutamine after status stabilization (at 8-10 days of disease were performed.Results. Dobutamine test (with low and high doses showed myocardial viability in patients of group B. Patients of group A had irreversible LV systolic dysfunction in 32 % of segments. Corvitin slowed down LV dilatation progression in patients with ACS+ST. It resulted in the end-diastolic and end-systolic indexes did not change within 10 days. The LV ejection fraction was more increased in patients of group B in comparison with patients of group A.Conclusion. The early corvitin prescribing has positive effects on LV systolic function and prevents post-reperfusion complications. 

  10. PREVENTION OF LEFT VENTRICLE SYSTOLIC DYSFUNCTION IN PATIENTS WITH ACUTE CORONARY SYNDROME WITH ST SEGMENT ELEVATION AFTER CARDIAC REVASCULARIZATION

    Directory of Open Access Journals (Sweden)

    A. L. Alyavi

    2009-01-01

    Full Text Available Aim. To study effects of bioflavonoid quercetin (corvitin on left ventricle (LV systolic dysfunction in patients with acute coronary syndrome with ST segment elevation (ACS+ST after cardiac revascularization.Material and methods. 60 patients with ACS+ST (44,2±1,3 y.o. were examined. Patients were admitted to hospital within 6 hours after complaints beginning. Patients were randomized in two groups. 30 patients of group A had standard therapy and cardiac revascularization. 30 patients of group B received corvitin additionally to standard therapy before cardiac revascularization. Echocardiography initially and stress-echocardiography with dobutamine after status stabilization (at 8-10 days of disease were performed.Results. Dobutamine test (with low and high doses showed myocardial viability in patients of group B. Patients of group A had irreversible LV systolic dysfunction in 32 % of segments. Corvitin slowed down LV dilatation progression in patients with ACS+ST. It resulted in the end-diastolic and end-systolic indexes did not change within 10 days. The LV ejection fraction was more increased in patients of group B in comparison with patients of group A.Conclusion. The early corvitin prescribing has positive effects on LV systolic function and prevents post-reperfusion complications. 

  11. 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.

  12. Left ventricular ejection fraction to predict early mortality in patients with non-ST-segment elevation acute coronary syndromes.

    Science.gov (United States)

    Bosch, Xavier; Théroux, Pierre

    2005-08-01

    Improvement in risk stratification of patients with non-ST-segment elevation acute coronary syndrome (ACS) is a gateway to a more judicious treatment. This study examines whether the routine determination of left ventricular ejection fraction (EF) adds significant prognostic information to currently recommended stratifiers. Several predictors of inhospital mortality were prospectively characterized in a registry study of 1104 consecutive patients, for whom an EF was determined, who were admitted for an ACS. Multiple regression models were constructed using currently recommended clinical, electrocardiographic, and blood marker stratifiers, and values of EF were incorporated into the models. Age, ST-segment shifts, elevation of cardiac markers, and the Thrombolysis in Myocardial Infarction (TIMI) risk score all predicted mortality (P model improved the prediction of mortality (C statistic 0.73 vs 0.67). The odds of death increased by a factor of 1.042 for each 1% decrement in EF. By receiver operating curves, an EF cutoff of 48% provided the best predictive value. Mortality rates were 3.3 times higher within each TIMI risk score stratum in patients with an EF of 48% or lower as compared with those with higher. The TIMI risk score predicts inhospital mortality in a broad population of patients with ACS. The further consideration of EF adds significant prognostic information.

  13. Management and outcomes of acute ST-segment-elevation myocardial infarction at a tertiary-care hospital in Sri Lanka: an observational study

    OpenAIRE

    Bandara, Ruwanthi; Medagama, Arjuna; Munasinghe, Ruwan; Dinamithra, Nandana; Subasinghe, Amila; Herath, Jayantha; Ratnayake, Mahesh; Imbulpitiya, Buddhini; Sulaiman, Ameena

    2015-01-01

    Background Sri Lanka is a developing country with a high rate of cardiovascular mortality. It is still largely dependent on thrombolysis for primary management of acute myocardial infarction. The aim of this study was to present current data on the presentation, management, and outcomes of acute ST-segment-elevation myocardial infarction (STEMI) at a tertiary-care hospital in Sri Lanka. Methods Eighty-one patients with acute STEMI presenting to a teaching hospital in Peradeniya, Sri Lanka, we...

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

    Science.gov (United States)

    Paul, G K; Sen, B; Rahman, M Z; Ali, M; Rahman, M M; Rokonuzzaman, S M

    2014-10-01

    The study was conducted in the Department of cardiology, NICVD Dhaka during the period January 2006 to December 2007 to assess the impact of platelet on ST-elevation myocardial infarction (STEMI). To perform this prospective study 200 patients with STEMI within 72 hours of chest pain of both sexes were randomly selected and were evaluated by clinical history, physical examination and with the help of ECG, Echocardiography and others cardiac risk factors analysis. Heparin therapy before admission, previously documented thrombocytopenia (1.6mg/dl) and history of PCI & CABG were excluded in this study. Patient of Platelet count (PC) ≤200000/cubic millimeter (cmm) in Group I and patient of Group II, platelet counts were PC >200000/cmm. Follow up period was 3 days to 7 days after hospital admission. Primary outcome heart failure (any Killip class) was significantly more in Group II than Group I (40.0% vs. 23.0%; p=0.009). Though the incidence of Killip class I and cardiogenic shock were not significant between these two groups but Killip class II (18.0% vs. 8.0%; p=0.036) and Killip class III (15.0% vs. 6.0%; p=0.037) heart failure were significantly more among the patient with higher platelet counts. In-hospital mortality, one of the primary outcomes of this study, was significantly higher in Group II (13.0%) than Group I (5.0 %) and p value was 0.048. Re-infarction was more in patient with higher platelet counts group (Group II) than patients with lower platelet count (Group I) but statistically was not significant (16.0% vs.11.0%; p=0.300).

  15. ST-Segment Elevation Myocardial Infarction with Acute Stent Thrombosis Presenting as Intractable Hiccups: An Unusual Case.

    Science.gov (United States)

    Zhang, Fan; Tongo, Nosakhare Douglas; Hastings, Victoria; Kanzali, Parisa; Zhu, Ziqiang; Chadow, Hal; Rafii, Shahrokh E

    2017-04-29

    BACKGROUND Acute coronary syndrome (ACS) can present with atypical chest pain or symptoms not attributed to heart disease, such as indigestion. Hiccups, a benign and self-limited condition, can become persistent or intractable with overlooked underlying etiology. There are various causes of protracted hiccups, including metabolic abnormalities, psychogenic disorders, malignancy, central nervous system pathology, medications, pulmonary disorders, or gastrointestinal etiologies. It is rarely attributed to cardiac disease. CASE REPORT We report a case of intractable hiccups in a 51-year-old male with cocaine related myocardial infarction (MI) before and after stent placement. Coronary angiogram showed in-stent thrombosis of the initial intervention. Following thrombectomy, balloon angioplasty, and stent, the patient recovered well without additional episodes of hiccups. Although hiccups are not known to present with a predilection for a particular cause of myocardial ischemia, this case may additionally be explained by the sympathomimetic effects of cocaine, which lead to vasoconstriction of coronary arteries. CONCLUSIONS Hiccups associated with cardiac enzyme elevation and EKG ST-segment elevation before and after percutaneous coronary intervention (PCI) maybe a manifestation of acute MI with or without stent. The fact that this patient was a cocaine user may have contributed to the unique presentation.

  16. 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)

    Chavarria, N.; Wong, C.; Hussain, H.; Joiya, H.U.

    2015-01-01

    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)

  17. 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

    . The latter group was divided into the following subgroups: 46 patients with proximal, 47 with mid and 10 with distal LAD occlusion. Three ST-segment based ECG features were investigated: (1) Existing criterion for differentiating anterior STEMI from TC: ST-segment depression >0.5mm in lead aVR...

  18. 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.

  19. Plasma bilirubin values on admission and ventricular remodeling after a first anterior ST-segment elevation acute myocardial infarction.

    Science.gov (United States)

    Miranda, Berta; Barrabés, José A; Figueras, Jaume; Pineda, Victor; Rodríguez-Palomares, José; Lidón, Rosa-Maria; Sambola, Antonia; Bañeras, Jordi; Otaegui, Imanol; García-Dorado, David

    2016-01-01

    Bilirubin may elicit cardiovascular protection and heme oxygenase-1 overexpression attenuated post-infarction ventricular remodeling in experimental animals, but the association between bilirubin levels and post-infarction remodeling is unknown. In 145 patients with a first anterior ST-segment elevation acute myocardial infarction (STEMI), we assessed whether plasma bilirubin on admission predicted adverse remodeling (left ventricular end-diastolic volume [LVEDV] increase ≥20% between discharge and 6 months, estimated by magnetic resonance imaging). Patients' baseline characteristics and management were comparable among bilirubin tertiles. LVEDV increased at 6 months (P bilirubin tertiles (10.8 [30.2], 10.1 [22.9], and 12.7 [24.3]%, P = 0.500). Median (25-75 percentile) bilirubin values in patients with and without adverse remodeling were 0.75 (0.60-0.93) and 0.73 (0.60-0.92) mg/dL (P = 0.693). Absence of final TIMI flow grade 3 (odds ratio 3.92, 95% CI 1.12-13.66) and a history of hypertension (2.04, 0.93-4.50), but not admission bilirubin, were independently associated with adverse remodeling. Bilirubin also did not predict the increase in ejection fraction at 6 months. Admission bilirubin values are not related to LVEDV or ejection fraction progression after a first anterior STEMI and do not predict adverse ventricular remodeling. Key messages Bilirubin levels are inversely related to cardiovascular disease, and overexpression of heme oxygenase-1 (the enzyme that determines bilirubin production) has prevented post-infarction ventricular remodeling in experimental animals, but the association between bilirubin levels and the progression of ventricular volumes and function in patients with acute myocardial infarction remained unexplored. In this cohort of patients with a first acute anterior ST-segment elevation myocardial infarction receiving contemporary management, bilirubin levels on admission were not predictive of the changes in left

  20. 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 K; 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-...

  1. 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...

  2. Correlation between GDF-15 gene polymorphism and the formation of collateral circulation in acute ST-elevation myocardial infarction.

    Science.gov (United States)

    Chen, Xiao-Ping; Shang, Xiao-Sen; Wang, Yan-Bin; Fu, Zhi-Hua; Gao, Yu; Feng, Tao

    2017-12-01

    To explore the correlation between growth differentiation factor 15 (GDF-15) -3148C/G polymorphism and the formation of collateral circulation in acute ST-elevation myocardial infarction (STEMI) in Han population of Taiyuan area. The present study included 92 STEMI patients and 56 normal controls based on coronary angiography; STEMI group was divided into collateral group and non-collateral group according to Rentrop's grading method. Polymerase chain reaction (PCR) and DNA sequencing methods were used to detect and analyze the GDF-15 -3148C/G polymorphism in all participants. There was significant difference in GDF-15 -3148C/G CC and GC distribution between STEMI group and control group (p=0.009); the allele frequencies between these two groups were also significant different (p=0.016); and the risk genotype for STEMI was CC with increased OR=2.660. For STEMI group, GDF-15 -3148C/G CC and GC distribution was also significantly different between patients with and without collateral (p=0.048), and CC genotype significantly promote the formation of collateral circulation. However, there were no significant differences in allele frequencies between these two subgroups of STEMI. There was correlation between GDF-15-3148C/G polymorphism and the formation of collateral circulation in patients with acute STEMI.

  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. Cardiac index after acute ST-segment elevation myocardial infarction measured with phase-contrast cardiac magnetic resonance imaging

    International Nuclear Information System (INIS)

    Klug, Gert; Reinstadler, Sebastian Johannes; Feistritzer, Hans-Josef; Schwaiger, Johannes P.; Reindl, Martin; Mair, Johannes; Mueller, Silvana; Franz, Wolfgang-Michael; Metzler, Bernhard; Kremser, Christian; Mayr, Agnes

    2016-01-01

    Phase-contrast CMR (PC-CMR) might provide a fast and robust non-invasive determination of left ventricular function in patients after ST-segment elevation myocardial infarction (STEMI). Cine sequences in the left-ventricular (LV) short-axis and free-breathing, retrospectively gated PC-CMR were performed in 90 patients with first acute STEMI and 15 healthy volunteers. Inter- and intra-observer agreement was determined. The correlations of clinical variables age, gender, ejection fraction, NT pro-brain natriuretic peptide [NT-proBNP] with cardiac index (CI) were calculated. For CI, there was a strong agreement of cine CMR with PC-CMR in healthy volunteers (r: 0.82, mean difference: -0.14 l/min/m 2 , error ± 23 %). Agreement was lower in STEMI patients (r: 0.61, mean difference: -0.17 l/min/m 2 , error ± 32 %). In STEMI patients, CI measured with PC-CMR showed lower intra-observer (1 % vs. 9 %) and similar inter-observer variability (9 % vs. 12 %) compared to cine CMR. CI was significantly correlated with age, ejection fraction and NT-proBNP values in STEMI patients. The agreement of PC-CMR and cine CMR for the determination of CI is lower in STEMI patients than in healthy volunteers. After acute STEMI, CI measured with PC-CMR decreases with age, LV ejection fraction and higher NT-proBNP. (orig.)

  5. Correlation between GDF-15 gene polymorphism and the formation of collateral circulation in acute ST-elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Xiao-ping Chen

    Full Text Available Summary Objective: To explore the correlation between growth differentiation factor 15 (GDF-15 -3148C/G polymorphism and the formation of collateral circulation in acute ST-elevation myocardial infarction (STEMI in Han population of Taiyuan area. Method: The present study included 92 STEMI patients and 56 normal controls based on coronary angiography; STEMI group was divided into collateral group and non-collateral group according to Rentrop's grading method. Polymerase chain reaction (PCR and DNA sequencing methods were used to detect and analyze the GDF-15 -3148C/G polymorphism in all participants. Results: There was significant difference in GDF-15 -3148C/G CC and GC distribution between STEMI group and control group (p=0.009; the allele frequencies between these two groups were also significant different (p=0.016; and the risk genotype for STEMI was CC with increased OR=2.660. For STEMI group, GDF-15 -3148C/G CC and GC distribution was also significantly different between patients with and without collateral (p=0.048, and CC genotype significantly promote the formation of collateral circulation. However, there were no significant differences in allele frequencies between these two subgroups of STEMI. Conclusion: There was correlation between GDF-15-3148C/G polymorphism and the formation of collateral circulation in patients with acute STEMI.

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

    Science.gov (United States)

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

    2016-01-01

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

  7. Long-term survival and causes of death in patients with ST-elevation acute coronary syndrome without obstructive coronary artery disease

    DEFF Research Database (Denmark)

    Andersson, Hedvig Bille; Pedersen, Frants; Engstrøm, Thomas

    2018-01-01

    Aims: We aimed to study survival and causes of death in patients with ST-elevation acute coronary syndrome (STE-ACS) with and without obstructive coronary artery disease (CAD). Methods and results: We included 4793 consecutive patients with STE-ACS triaged for acute coronary angiography at a larg...... than patients with obstructive CAD. Causes of death were less often cardiovascular. This suggests that STE-ACS patients without obstructive CAD warrant medical attention and close follow-up.......Aims: We aimed to study survival and causes of death in patients with ST-elevation acute coronary syndrome (STE-ACS) with and without obstructive coronary artery disease (CAD). Methods and results: We included 4793 consecutive patients with STE-ACS triaged for acute coronary angiography at a large...

  8. 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)

    Natarajan, Deepak

    2015-01-01

    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

  9. 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.

  10. ST-segment depression in aVR as a predictor of culprit artery in acute inferior wall ST-segment elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Ahmed Hafez el-neklawy

    2014-03-01

    Conclusions: ST depression in aVR is common in patients with LCX-related acute inferior myocardial infarction. The ST changes in this lead are associated with an excellent specificity and a good sensitivity in differentiating LCX from RCA as the IRA.

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

    Science.gov (United States)

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

    2014-11-01

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

  12. 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

  13. Atypical Presentation of Acute Coronary Syndrome-Not ST Elevation: A Case Report

    Directory of Open Access Journals (Sweden)

    Nicola Vitulano

    2012-01-01

    Full Text Available We describe the unexpected case of a 70-year-old man, with medical history of ischemic heart disease and surgery for aneurysm of abdominal aorta, who comes to the emergency department complaining of low-back pain without other symptoms or signs of organic failure. After a few hours we see a deterioration of physical conditions with pulmonary oedema, increase of blood pressure, changing in the ECG pattern, and worsening of left ventricular function with progressive increase of biomarkers for myocardial necrosis. So this pain has revealed the premature symptom of an acute coronary syndrome (ACS. After a short time a subsequent cardiac arrest complicates the clinical situation. After resuscitation, the patient undergoes successfully to coronary angiography and performed a percutaneous transluminal coronary angioplasty (PTCA.

  14. Comparison of Functional Capacity using Primary Percutaneous Coronary Intervention with Pharmacological Therapy on ST Elevation Acute Coronary Syndrome Patients

    Directory of Open Access Journals (Sweden)

    Andini Nurkusuma Wardhani

    2015-06-01

    Full Text Available Background: Acute Coronary Syndrome (ACS is a shift manifestations pattern of ischemic myocardium. Revascularization either with Primary Percutaneous Coronary Intervention (PCI or pharmacological therapy is an optional treatment for ST Elevation Acute Coronary Syndrome (STEACS patients. The aim of the study was to compare the functional capacity using six-minute walking test on STEACS patients who underwent Primary PCI or pharmacological therapy. Methods: A cross sectional study was conducted from September to October 2012 to 35 STEACS patients who were treated after two years. The samples were obtained from the list of patients at Dr. Hasan Sadikin General Hospital. Inclusion criteria consisted of patients diagnosed as STEACS, cooperative and not experiencing cognitive disturbance. The exclusion criteria were STEACS patients with unstable angina or myocardial infarct in the last month, stable exertional angina, and pregnant women. The patients underwent 6 minutes walking test,VO2max was measured using theCalahin and Cooper formula, then Metabolic Equation Task (METs was calculated. Data were analyzed by unpaired T-test. Results: There were 19 Primary PCI and 16 pharmacological therapy patients. The average of age between the two groups was distributed evenly. Most of the STEACS patients were male, had a college/academic degree and were retired. Patients treated with pharmacological therapy had higher average of VO2 max and METs than patients with Primary PCI. There was no significantly differences of METs between those groups (p>0.05 Conclusions: There were no significantly differences of functional capacity in STEACS patients treated with Primary PCI or Pharmacological therapy.

  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. Cost-Effectiveness Analysis of Fondaparinux vs Enoxaparin in Non-ST Elevation Acute Coronary Syndrome in Thailand.

    Science.gov (United States)

    Permsuwan, Unchalee; Chaiyakunapruk, Nathorn; Nathisuwan, Surakit; Sukonthasarn, Apichard

    2015-09-01

    Non-ST elevation acute coronary syndrome (NSTE-ACS) imposes a significant health and economic burden on a society. Anticoagulants are recommended as standard therapy by various clinical practice guidelines. Fondaparinux was introduced and evaluated in a number of large randomised, controlled trials. This study therefore aimed to determine the cost-effectiveness of fondaparinux versus enoxaparin in the treatment of NSTE-ACS in Thailand. A two-part construct model comprising a one-year decision tree and a Markov model was developed to capture short and long-term costs and outcomes from the perspective of provider and society. Effectiveness data were derived from OASIS-5 trial while bleeding rates were derived from the Thai Acute Coronary Syndrome Registry (TACSR). Costs data were based on a Thai database and presented in the year of 2013. Both costs and outcomes were discounted by 3% annually. A series of sensitivity analyses were performed. The results showed that compared with enoxaparin, fondaparinux was a cost-saving strategy (lower cost with slightly higher effectiveness). Cost of revascularisation with major bleeding had a greater impact on the amount of cost saved both from societal and provider perspectives. With a threshold of 160,000 THB ((4,857.3 USD) per QALY in Thailand, fondaparinux was about 99% more cost-effective compared with enoxaparin. Fondaparinux should be considered as a cost-effective alternative when compared to enoxaparin for NSTE-ACS based on Thailand's context, especially in the era of limited healthcare resources. Copyright © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    David Corcoran

    2015-09-01

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

  18. [Women and acute coronary syndrome with ST elevation: Excess mortality related to longer delays and spontaneous coronary dissection].

    Science.gov (United States)

    Benamer, H; Motreff, P; Jessen, P; Piquet, M; Haziza, F; Chevalier, B

    2015-12-01

    The outcome of patients with ST elevation acute coronary syndrome (ACS) has been increasingly improving in the general population over the past few decades. However, detailed analysis of the results show that the reduction in mortality rates is higher in males compared to their female counterparts. The excess mortality rate observed in women, though sometimes questioned, has been widely reported in the literature. The higher mortality rate observed in women with ST elevation ACS can be explained by the presence of aggravating clinical factors such as older age, a higher percentage of diabetics, and a higher frequency of cardiogenic shock. Other factors pertaining to patient management seem to negatively impact the outcome. These factors include a lower use of reperfusion strategies, longer time to treatment mainly as a result of diagnostic uncertainty with respect to a disease, which is believed to affect principally the male gender. The doubts that female patients themselves and their families have about the nature of their symptoms are also present in the medical environment but cease to exist in the catheterization laboratory. This is illustrated in the first clinical case that we present here. Coronary reperfusion is the cornerstone of the therapeutic management of MI. In this context, bleeding complications associated with the implemented treatments can also result in an increased mortality rate in this more vulnerable population. When all the factors likely to influence the prognosis are taken into account, excess mortality seems to persist in women, especially in younger patients. As described in the second clinical case, a distinct physio-pathological factor, more frequent in women, could account for this higher mortality rate. Indeed, spontaneous coronary dissection and intramural hematoma are not always easy to diagnose and may not be adequately managed by reperfusion treatments. In addition, these coronary reperfusion strategies are probably not adapted

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

    NARCIS (Netherlands)

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

    2007-01-01

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

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

    NARCIS (Netherlands)

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

    2007-01-01

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

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

    NARCIS (Netherlands)

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

    2007-01-01

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

  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...

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

    International Nuclear Information System (INIS)

    Zheng Hongchao; Zhang Qi; Zhang Ruiyan; Hu Jian; Yang Zhenkun; Zhang Jiansheng; Shen Weifeng

    2009-01-01

    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)

  4. Absolute coronary blood flow measurement and microvascular resistance in ST-elevation myocardial infarction in the acute and subacute phase

    Energy Technology Data Exchange (ETDEWEB)

    Wijnbergen, Inge; Veer, Marcel van ' t [Department of Cardiology, Catharina Hospital, Eindhoven (Netherlands); Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven (Netherlands); Lammers, Jeroen; Ubachs, Joey [Department of Cardiology, Catharina Hospital, Eindhoven (Netherlands); Pijls, Nico H.J., E-mail: nico.pijls@cze.nl [Department of Cardiology, Catharina Hospital, Eindhoven (Netherlands); Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven (Netherlands)

    2016-03-15

    Background/Purpose: In a number of patients with acute myocardial infarction (AMI), myocardial hypoperfusion, known as the no-reflow phenomenon, persists after primary percutaneous intervention (PPCI). The aim of this study was to evaluate the feasibility and safety of a new quantitative method of measuring absolute blood flow and resistance within the perfusion bed of an infarct-related artery. Furthermore, we sought to study no-reflow by correlating these measurements to the index of microvascular resistance (IMR) and the area at risk (AR) as determined by cardiac magnetic resonance imaging (CMR). Methods: Measurements of absolute flow and myocardial resistance were performed in 20 patients with ST-segment elevation myocardial infarction (STEMI), first immediately following PPCI and then again after 3–5 days. These measurements used the technique of thermodilution during a continuous infusion of saline. Flow was expressed in ml/min per gram of tissue within the area at risk. Results: The average time needed for measurement of absolute flow, resistance and IMR was 20 min, and all measurements could be performed without complication. A higher flow supplying the AR correlated with a lower IMR in the acute phase. Absolute flow increased from 3.14 to 3.68 ml/min/g (p = 0.25) and absolute resistance decreased from 1317 to 1099 dyne.sec.cm-5/g (p = 0.40) between the first day and fifth day after STEMI. Conclusions: Measurement of absolute flow and microvascular resistance is safe and feasible in STEMI patients and may allow for a better understanding of microvascular (dys)function in the early phase of AMI. - Highlights: • We measured absolute coronary blood flow and microvascular resistance in STEMI patients in the acute phase and in the subacute phase, using the technique of thermodilution with low grade intracoronary continuous infusion of saline. • These measurements are safe and feasible during PPCI in STEMI patients. • In STEMI patients, absolute flow

  5. 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

  6. Design and implementation of the TRACIA: intracoronary autologous transplant of bone marrow-derived stem cells for acute ST elevation myocardial infarction

    OpenAIRE

    Peña-Duque, Marco A.; Martínez-Ríos, Marco A.; Calderón G, Eva; Mejía, Ana M.; Gómez, Enrique; Martínez-Sánchez, Carlos; Figueroa, Javier; Gaspar, Jorge; González, Héctor; Bialoztosky, David; Meave, Aloha; Uribe-González, Jhonathan; Alexánderson, Erick; Ochoa, Victor; Masso, Felipe

    2011-01-01

    Objective: To describe the design of a protocol of intracoronary autologous transplant of bone marrow-derived stem cells for acute ST-elevation myocardial infarction (STEMI) and to report the safety of the procedure in the first patients included. Methods: The TRACIA study was implemented following predetermined inclusion and exclusion criteria. The protocol includes procedures such as randomization, bone marrow retrieval, stem cells processing, intracoronary infusion of stem cells in the inf...

  7. The predictive value of P-wave duration by signal-averaged electrocardiogram in acute ST elevation myocardial infarction.

    Science.gov (United States)

    Shturman, Alexander; Bickel, Amitai; Atar, Shaul

    2012-08-01

    The prognostic value of P-wave duration has been previously evaluated by signal-averaged ECG (SAECG) in patients with various arrhythmias not associated with acute myocardial infarction (AMI). To investigate the clinical correlates and prognostic value of P-wave duration in patients with ST elevation AMI (STEMI). The patients (n = 89) were evaluated on the first, second and third day after admission, as well as one week and one month post-AMI. Survival was determined 2 years after the index STEMI. In comparison with the upper normal range of P-wave duration ( 40% (128.79 +/- 28 msec) (P = 0.001). P-wave duration above 120 msec was significantly correlated with increased complication rate; namely, sustained ventricular tachyarrhythmia (36%), congestive heart failure (41%), atrial fibrillation (11%), recurrent angina (14%), and re-infarction (8%) (P = 0.012, odds ratio 4.267, 95% confidence interval 1.37-13.32). P-wave duration of 126 msec on the day of admission was found to have the highest predictive value for in-hospital complications including LVEF 40% (area under the curve 0.741, P < 0.001). However, we did not find a significant correlation between P-wave duration and mortality after multivariate analysis. P-wave duration as evaluated by SAECG correlates negatively with LVEF post-STEMI, and P-wave duration above 126 msec can be utilized as a non-invasive predictor of in-hospital complications and low LVEF following STEMI.

  8. The Severity of Coronary Arterial Stenosis in Patients With Acute ST-Elevated Myocardial Infarction: A Thrombolytic Therapy Study

    Science.gov (United States)

    Kilic, Salih; Kocabas, Umut; Can, Levent Hurkan; Yavuzgil, Oguz; Zoghi, Mehdi

    2018-01-01

    Background It is widely believed that ST-elevated myocardial infarction (STEMI) generally occurs at the site of mild to moderate coronary stenosis. The aim of this study was to determine the degree of stenosis of infarct-related artery (IRA) in STEMI patients who underwent coronary angiography (CAG) after successful reperfusion with thrombolytic therapy (TT). Methods A total of 463 consecutive patients between January 2008 and December 2013 with acute STEMI treated with TT were evaluated retrospectively. The patients in whom reperfusion failed (n = 120), death occurred before CAG (n = 12), IRA cannot be determined (n = 10), and CAG was not performed in index hospitalization (n = 54) were excluded from the study. To determine the severity of stenosis of IRA, two experienced cardiologists who were unaware of each other used quantitative CAG analysis. Significant stenosis was defined as a ≥ 50% stenosis in the coronary artery lumen. A total of 267 patients who were successfully reperfused with TT and in whom CAG was performed during hospitalization with median 8 (1 - 17) days after myocardial infarction were included in the study. Results The mean age of patients was 55.7 ± 10.8 years (85.5% male). Most of the patients had a significant stenosis in IRA ( ≥ 50%, n = 236, group 1) after successful TT; whereas only 11.6% had stenosis < 50% (n = 31, group 2). In addition, majority of the patients had ≥ 70.4% (n = 188, 70.4%) stenosis in IRA. Average of stenosis in IRA was 74±16%. Conclusions In contrast to the general opinion, we detected that majority of STEMI patients had a significant stenosis in IRA. PMID:29479380

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

    Science.gov (United States)

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

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

  10. Period3 VNTR polymorphism influences the time-of-day pain onset of acute myocardial infarction with ST elevation.

    Science.gov (United States)

    Lipkova, Jolana; Splichal, Zbynek; Bienertova-Vasku, Julie Anna; Jurajda, Michal; Parenica, Jiri; Vasku, Anna; Goldbergova, Monika Pavkova

    2014-10-01

    It is well established that the incidence and infarct size in acute myocardial infarction (AMI) is subject to circadian variations. At the molecular level, circadian clocks in distinct cells, including cardiomyocytes, generate 24-h cycles of biochemical processes. Possible imbalance or impairment in the cell clock mechanism may alter the cardiac metabolism and function and increase the susceptibility of cardiovascular diseases. One of the key components of the human clock system PERIOD3 (PER3) has been recently demonstrated to affect circadian expression of various genes in different tissues, including the heart. The variable number tandem repeat (VNTR) polymorphism (rs57875989) in gene Period3 (Per3) is related to multiple phenotypic parameters, including diurnal preference, sleep homeostasis, infection and cancer. The aim of our study was to investigate the effect of this polymorphism in AMI with ST elevation (STEMI). The study subjects (314 patients of Caucasian origin with STEMI, and 332 healthy controls) were genotyped for Per3 VNTR polymorphism using an allele-specific polymerase chain reaction. A gender difference in circadian rhythmicity of pain onset was observed with significant circadian pattern in men. Furthermore, the Per3(5/5) variant carriers were associated with higher levels of interleukin-6, B-type natriuretic peptide and lower vitamin A levels. By using cosinor analysis we observed different circadian distribution patterns of AMI onset at the level of genotype and allelic frequencies. Genotypes with at least one 4-repeat allele (Per3(4/5) and Per3(4/4)) (N = 264) showed remarkable circadian activity in comparison with Per3(5/5) (N = 50), especially in men. No significant differences in genotype and/or allele frequencies of Per3 VNTR polymorphism were observed when comparing STEMI cases and controls. Our results indicate that the Per3 VNTR may contribute to modulation of cardiac functions and interindividual differences in development and

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

    Science.gov (United States)

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

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

  12. Algorithm for the automatic computation of the modified Anderson-Wilkins acuteness score of ischemia from the pre-hospital ECG in ST-segment elevation myocardial infarction

    DEFF Research Database (Denmark)

    Fakhri, Yama; Sejersten-Ripa, Maria; Schoos, Mikkel Malby

    2017-01-01

    BACKGROUND: The acuteness score (based on the modified Anderson-Wilkins score) estimates the acuteness of ischemia based on ST-segment, Q-wave and T-wave measurements obtained from the electrocardiogram (ECG) in patients with ST Elevation Myocardial Infarction (STEMI). The score (range 1 (least...... the acuteness score. METHODS: We scored 50 pre-hospital ECGs from STEMI patients, manually and by the automated algorithm. We assessed the reliability test between the manual and automated algorithm by interclass correlation coefficient (ICC) and Bland-Altman plot. RESULTS: The ICC was 0.84 (95% CI 0.......72-0.91), PECGs, all within the upper (1.46) and lower (-1.12) limits...

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

    Science.gov (United States)

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

    2005-02-01

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

  14. A Cost-Effectiveness Analysis of Clopidogrel for Patients with Non-ST-Segment Elevation Acute Coronary Syndrome in China.

    Science.gov (United States)

    Cui, Ming; Tu, Chen Chen; Chen, Er Zhen; Wang, Xiao Li; Tan, Seng Chuen; Chen, Can

    2016-09-01

    There are a number of economic evaluation studies of clopidogrel for patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) published from the perspective of multiple countries in recent years. However, relevant research is quite limited in China. We aimed to estimate the long-term cost effectiveness for up to 1-year treatment with clopidogrel plus acetylsalicylic acid (ASA) versus ASA alone for NSTEACS from the public payer perspective in China. This analysis used a Markov model to simulate a cohort of patients for quality-adjusted life years (QALYs) gained and incremental cost for lifetime horizon. Based on the primary event rates, adherence rate, and mortality derived from the CURE trial, hazard functions obtained from published literature were used to extrapolate the overall survival to lifetime horizon. Resource utilization, hospitalization, medication costs, and utility values were estimated from official reports, published literature, and analysis of the patient-level insurance data in China. To assess the impact of parameters' uncertainty on cost-effectiveness results, one-way sensitivity analyses were undertaken for key parameters, and probabilistic sensitivity analysis (PSA) was conducted using the Monte Carlo simulation. The therapy of clopidogrel plus ASA is a cost-effective option in comparison with ASA alone for the treatment of NSTEACS in China, leading to 0.0548 life years (LYs) and 0.0518 QALYs gained per patient. From the public payer perspective in China, clopidogrel plus ASA is associated with an incremental cost of 43,340 China Yuan (CNY) per QALY gained and 41,030 CNY per LY gained (discounting at 3.5% per year). PSA results demonstrated that 88% of simulations were lower than the cost-effectiveness threshold of 150,721 CYN per QALY gained. Based on the one-way sensitivity analysis, results are most sensitive to price of clopidogrel, but remain well below this threshold. This analysis suggests that treatment with

  15. Inferior ST-Elevation Acute Myocardial Infarction or an Inferior-Lead Brugada-like Electrocardiogram Pattern Associated With the Use of Pregabalin and Quetiapine?

    Science.gov (United States)

    Brunetti, Natale D; Ieva, Riccardo; Correale, Michele; Cuculo, Andrea; Santoro, Francesco; Guaricci, Andrea I; De Gennaro, Luisa; Gaglione, Antonio; Di Biase, Matteo

    2016-01-01

    The Brugada electrocardiogram pattern is characterized by coved-type ST-elevation (>2 mm) in the right precordial leads. We report the case of a 62-year-old man, with bipolar disorder, admitted to the emergency department because of dyspnea and chest discomfort. The patient was on treatment with pregabalin and quetiapine. Unexpectedly, electrocardiogram at admission showed diffuse ST-elevation, more evident in inferior leads, where a Brugada-like pattern was present. The patient underwent coronary angiography with a diagnosis of suspected acute coronary syndrome. Coronary angiography, however, showed mild coronary artery disease not requiring coronary angioplasty. Echocardiography did not reveal left ventricular dysfunction or pericardial effusion. Troponin levels remained normal over serial controls. Eventually, chest radiography showed lung opacities and consolidation suggestive for pneumonia. To the best of our knowledge, this is one of the first cases showing a transient Brugada-like electrocardiogram pattern in inferior leads, probably amplified by the administration of pregabalin and quetiapine.

  16. Myocarditis with ST elevation and elevated cardiac enzymes misdiagnosed as an ST-elevation myocardial infarction.

    Science.gov (United States)

    Sheldon, Seth H; Crandall, Mark A; Jaffe, Allan S

    2012-12-01

    Acute myocarditis can mimic ST-elevation myocardial infarction (STEMI). Quickly determining the correct diagnosis is critical given the "time is muscle" implication with a STEMI and the potential adverse effects associated with use of fibrinolytic therapy. A 46-year-old man presented to a rural emergency department with chest pain, and an electrocardiogram (ECG) read as showing 0.1 mV of ST-segment elevation in leads III and aVF. His initial cardiac troponin T was 0.44 ng/mL. He received fibrinolytic therapy for presumed STEMI. Cardiac magnetic resonance imaging was later performed and showed epicardial delayed enhancement consistent with myocarditis. Upon further questioning, he acknowledged 3 days of stuttering chest discomfort and a recent upper respiratory infection, as well as similar chest pain in his wife. A systematic evaluation is essential for acute chest pain, including a focused history, identification of cardiac risk factors, and ECG interpretation. A history of recent viral illness, absence of cardiac risk factors, or ECG findings inconsistent with a single anatomic lesion would suggest a potential alternate diagnosis to STEMI. This case emphasizes the importance of a focused history in the initial evaluation of chest pain. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. Clinical study on the effect of Tongxinluo combined with trimetazidine on cardiac function in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Qun-Xiong Fan

    2017-07-01

    Full Text Available Objective: To investigate the clinical effect of Tongxinluo combined with trimetazidine on cardiac function in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention. Method: From March 2014 to September 2016, we selected 190 patients with ST-segment elevation myocardial infarction with percutaneous coronary intervention, according to the admission time is divided into observation group and control group, the control group was treated with conventional therapy (aspirin, isosorbide dinitrate, metoprolol tartrate, clopidogrel sulfate, captopril, atorvastatin calcium and diuretics and trimetazidine, observation group in the control group based on Tongxinluo combined treatment, each group of 95 cases, and hs-CRP, aldosterone, NT-proBNP, TNF-α, IL-6, and cardiac function (LVEDV, LVESV, LVEF, SV were compared. Result: The Hs-CRP in the observation group was significantly lower than that in the control group; The aldosterone in the observation group was significantly lower than that in the control group; The levels of NT-proBNP, TNF-α and IL-6 in the observation group were significantly lower than those in the control group; LVVEV and LVESV were significantly lower in the observation group than in the control group, LVEF and SV were significantly higher than those in the control group. Conclusion: Tongxinluo combined with trimetazidine in patients with acute STsegment elevation myocardial infarction after percutaneous coronary intervention in patients with clinical effect is better, stable plaque, effectively improve microcirculation and cardiac function, recommended a wide range of clinical application.

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

    DEFF Research Database (Denmark)

    Zeymer, Uwe; Montalescot, Gilles; Ardissino, Diego

    2016-01-01

    The optimal time-point of the initiation of P2Y12 antagonist therapy in patients with non-ST elevation acute coronary syndromes (NTSE-ACS) is still a matter of debate. European guidelines recommend P2Y12 as soon as possible after first medical contact. However, the only trial which compared the two...... strategies did not demonstrate any benefit of pre-treatment with prasugrel before angiography compared to starting therapy after angiography and just prior to percutaneous coronary intervention (PCI). This paper summarizes the results of pharmacodynamic and previous studies, and gives recommendations...

  19. 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

    days, was not significantly different between treatment groups. There were no significant differences in the CMR-assessed myocardial salvage index (1-infarct size/myocardium at risk) (mean 52 vs. 58% with placebo, P = 0.1000), mean CMR-assessed infarct size (21.9 g vs. 20.0 g, or 17 vs. 15% of LV......-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......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...

  20. Thrombus aspiration combined with intra-coronary injection of Tirofiban for acute ST-segment elevation myocardial infarction: its influence on myocardial reperfusion

    International Nuclear Information System (INIS)

    Yin Da; Zhu Hao; Zhou Xuchen; Huang Rongchong; Zhang Bo; Wang Shaopeng; Zhang Yousheng; Jia Yuqing; Sun Menghan; Cui Hashen

    2011-01-01

    Objective: To explore the influence of thrombus aspiration combined with intra-coronary administration of the glycoprotein Ⅱ b/Ⅲ a inhibitor, Tirofiban, on myocardial microcirculation when percutaneous coronary intervention (PCI) is employed for the treatment of acute ST-segment elevation myocardial infarction. Methods: During the period from April 2008 to June 2010, percutaneous coronary interventional was performed in 184 consecutive patients with acute ST-segment elevation myocardial infarction. The patients were randomly divided into study group (n=78) and control group (n=106). Thrombus aspiration combined with intra-coronary administration of Tirofiban was used in patients of study group, while routine PCI together with intravenous administration of Tirofiban was adopted in patients of control group. Clinical features, TIMI grade, myocardial blush grade, ratio of ST falling >70% at 24 hours after treatment, incidence of massive haemorrhage, hospitalization, days, major adverse cardiac event within 30 days were observed, and the results were compared between two groups. Results: The incidence of no reflow phenomenon in study group was markedly lower than that in control group (5.67% vs. 21.14%, P=0.011), while the myocardial blush grade was much higher in study group than that in control group (2.03±0.32 vs. 1.12±0.47, P=0.021). The ratio of ST falling > 70% at 24 hours after treatment in study group was increased (94% vs. 85%, P=0.003), and the occurrence of perioperative massive haemorrhage was lower (9% vs. 4%, P=0.03). The incidence of major adverse cardiac event within 30 days was distinctly decreased although it was quite similar in both groups (5.5% vs. 6.1%, P=0.786). Conclusion: Thrombus aspiration combined with intra-coronary administration of Tirofiban is superior to conventional PCI in effectively improving the reperfusion of myocardial microcirculation and in reliably reducing perioperative risk. (authors)

  1. 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.

  2. Ventricular septal rupture, right ventricular free wall rupture, hemopericardium, cardiac tamponade, cardiogenic shock, and death in a patient with acute ST elevation myocardial infarction during transthoracic echocardiography

    Directory of Open Access Journals (Sweden)

    Osama A El Kady

    2017-01-01

    Full Text Available The incidence of mechanical complications related to myocardial infarction has decreased due to various factors over the last few decades. Patients admitted for acute ST segment elevation myocardial infarction (STEMI may respond well to thrombolytic therapy before being taken up for coronary angiography and percutaneous coronary intervention depending on the facilities available at the specific center. Unfortunately, some patients develop complications of myocardial infarction during hospital stay or postdischarge. We present a patient admitted with acute STEMI responding well to thrombolytic therapy. During transthoracic echocardiography of the patient in Intensive Care Unit, the patient developed ventricular septal rupture, right ventricular free wall rupture, hemopericardium, cardiac tamponade, and cardiogenic shock and expired.

  3. 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.

  4. Influence of inpatient service specialty on care processes and outcomes for patients with non ST-segment elevation acute coronary syndromes.

    Science.gov (United States)

    Roe, Matthew T; Chen, Anita Y; Mehta, Rajendra H; Li, Yun; Brindis, Ralph G; Smith, Sidney C; Rumsfeld, John S; Gibler, W Brian; Ohman, E Magnus; Peterson, Eric D

    2007-09-04

    Since the broad dissemination of practice guidelines, the association of specialty care with the treatment of patients with acute coronary syndromes has not been studied. We evaluated 55 994 patients with non-ST-segment elevation acute coronary syndromes (ischemic ST-segment changes and/or positive cardiac markers) included in the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines) Quality Improvement Initiative from January 2001 through September 2003 at 301 tertiary US hospitals with full revascularization capabilities. We compared baseline characteristics, the use of American College of Cardiology/American Heart Association guidelines class I recommendations, and in-hospital outcomes by the specialty of the primary in-patient service (cardiology versus noncardiology). A total of 35 374 patients (63.2%) were primarily cared for by a cardiology service, and these patients had lower-risk clinical characteristics, but they more commonly received acute (processes were improved when care was provided by a cardiology service regardless of the propensity to receive cardiology care. The adjusted risk of in-hospital mortality was lower with care provided by a cardiology service (adjusted odds ratio 0.80, 95% confidence interval 0.73 to 0.88), and adjustment for differences in the use of acute medications and invasive procedures partially attenuated this mortality difference (adjusted odds ratio 0.92, 95% confidence interval 0.83 to 1.02). Non-ST-segment elevation acute coronary syndrome patients primarily cared for by a cardiology inpatient service more commonly received evidence-based treatments and had a lower risk of mortality, but these patients had lower-risk clinical characteristics. Results from the present analysis highlight the difficulties with accurately determining how specialty care is associated with treatment patterns and clinical outcomes for patients with acute

  5. Single spot albumin to creatinine ratio: A simple marker of long-term prognosis in non-ST segment elevation acute coronary syndromes.

    Science.gov (United States)

    Higa, Claudio Cesar; Novo, Fedor Anton; Nogues, Ignacio; Ciambrone, Maria Graciana; Donato, Maria Sol; Gambarte, Maria Jimena; Rizzo, Natalia; Catalano, Maria Paula; Korolov, Eugenio; Comignani, Pablo Dino

    2016-01-01

    Microalbuminuria is a known risk factor for cardiovascular morbidity and mortality suggesting that it should be a marker of endothelial dysfunction. Albumin to creatinine ratio (ACR) is an available and rapid test for microalbuminuria determination, with a high correlation with the 24-h urine collection method. There is no prospective study that evaluates the prognostic value of ACR in patients with non ST-segment elevation acute coronary syndromes (NSTE-ACS). The purpose of our study was to detect the long-term prognostic value of ACR in patients with NSTE-ACS. Albumin to creatinine ratio was estimated in 700 patients with NSTE-ACS at admission. Median follow-up time was 18 months. The best cutoff point of ACR for death or acute myocardial infarction was 20 mg/g. Twenty-two percent of patients had elevated ACR. By multivariable Cox regression analysis, ACR was an independent predictor of the clinical endpoint: odds ratio 5.8 (95% confidence interval [CI] 2-16), log-rank 2 p 65 years, female gender, diabetes mellitus, creatinine clearance, glucose levels at admission, elevated cardiac markers (troponin T/CK-MB) and ST segment depression. The addition of ACR significantly improved GRACE score C-statistics from 0.69 (95% CI 0.59-0.83) to 0.77 (95% CI 0.65-0.88), SE 0.04, 2 p = 0.03, with a good calibration with both models. Albumin to creatinine ratio is an independent and accessible predictor of long-term adverse outcomes in NSTE-ACS, providing additional value for risk stratification.

  6. Comparison of Immediate With Delayed Stenting Using the Minimalist Immediate Mechanical Intervention Approach in Acute ST-Segment-Elevation Myocardial Infarction: The MIMI Study.

    Science.gov (United States)

    Belle, Loic; Motreff, Pascal; Mangin, Lionel; Rangé, Grégoire; Marcaggi, Xavier; Marie, Antoine; Ferrier, Nadine; Dubreuil, Olivier; Zemour, Gilles; Souteyrand, Géraud; Caussin, Christophe; Amabile, Nicolas; Isaaz, Karl; Dauphin, Raphael; Koning, René; Robin, Christophe; Faurie, Benjamin; Bonello, Laurent; Champin, Stanislas; Delhaye, Cédric; Cuilleret, François; Mewton, Nathan; Genty, Céline; Viallon, Magalie; Bosson, Jean Luc; Croisille, Pierre

    2016-03-01

    Delayed stent implantation after restoration of normal epicardial flow by a minimalist immediate mechanical intervention aims to decrease the rate of distal embolization and impaired myocardial reperfusion after percutaneous coronary intervention. We sought to confirm whether a delayed stenting (DS) approach (24-48 hours) improves myocardial reperfusion, versus immediate stenting, in patients with acute ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention. In the prospective, randomized, open-label minimalist immediate mechanical intervention (MIMI) trial, patients (n=140) with ST-segment-elevation myocardial infarction ≤12 hours were randomized to immediate stenting (n=73) or DS (n=67) after Thrombolysis In Myocardial Infarction 3 flow restoration by thrombus aspiration. Patients in the DS group underwent a second coronary arteriography for stent implantation a median of 36 hours (interquartile range 29-46) after randomization. The primary end point was microvascular obstruction (% left ventricular mass) on cardiac magnetic resonance imaging performed 5 days (interquartile range 4-6) after the first procedure. There was a nonsignificant trend toward lower microvascular obstruction in the immediate stenting group compared with DS group (1.88% versus 3.96%; P=0.051), which became significant after adjustment for the area at risk (P=0.049). Median infarct weight, left ventricular ejection fraction, and infarct size did not differ between groups. No difference in 6-month outcomes was apparent for the rate of major cardiovascular and cerebral events. The present findings do not support a strategy of DS versus immediate stenting in patients with ST-segment-elevation infarction undergoing primary percutaneous coronary intervention and even suggested a deleterious effect of DS on microvascular obstruction size. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01360242. © 2016 American Heart Association, Inc.

  7. Magnitude and consequences of undertreatment of high-risk patients with non-ST segment elevation acute coronary syndromes: insights from the DESCARTES Registry.

    Science.gov (United States)

    Heras, M; Bueno, H; Bardají, A; Fernández-Ortiz, A; Martí, H; Marrugat, J

    2006-11-01

    To analyse intensity of treatment of high-risk patients with non-ST elevation acute coronary syndromes (NSTEACS) included in the DESCARTES (Descripción del Estado de los Sindromes Coronarios Agudos en un Registro Temporal Español) registry. Patients with NSTEACS (n = 1877) admitted to 45 randomly selected Spanish hospitals in April and May 2002 were studied. Patients with ST segment depression and troponin rise were considered high risk (n = 478) and were compared with non-high risk patients (n = 1399). 46.9% of high-risk patients versus 39.5% of non-high-risk patients underwent angiography (p = 0.005), 23.2% versus 18.8% (p = 0.038) underwent percutaneous revascularisation, and 24.9% versus 7.4% (p or = 4, 2-3 and or = 4 (OR 2.87, 95% CI 1.27 to 6.52, p = 0.012). Class I recommended treatments were underused in high-risk patients in the DESCARTES registry. This undertreatment was an independent predictor of death of patients with an acute coronary syndrome.

  8. 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.)

  9. Elevated Plasma IL-38 Concentrations in Patients with Acute ST-Segment Elevation Myocardial Infarction and Their Dynamics after Reperfusion Treatment.

    Science.gov (United States)

    Zhong, Yucheng; Yu, Kunwu; Wang, Xiang; Wang, Xiaoya; Ji, Qingwei; Zeng, Qiutang

    2015-01-01

    Recent studies suggest that IL-38 is associated with autoimmune diseases. Furthermore, IL-38 is expressed in human atheromatous plaque. However, the plasma levels of IL-38 in patients with ST-segment elevation myocardial infarction (STEMI) have not yet to be investigated. On admission, at 24 h, at 48 h, and at 7 days, plasma IL-38, C-reactive protein (CRP), cardiac troponin I (cTNI), and N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) levels were measured and IL-38 gene in peripheral blood mononuclear cells (PBMCs) was detected in STEMI patients. The results showed that plasma IL-38 levels and IL-38 gene expression in PBMCs were significantly increased in STEMI patients compared with control group and were time dependent, peaked at 24 h. In addition, plasma IL-38 levels were dramatically reduced in patients with reperfusion treatment compared with control group. Similar results were also demonstrated with CRP, cTNI, and NT-proBNP levels. Furthermore, IL-38 levels were found to be positively correlated with CRP, cTNI, and NT-proBNP and be weakly negatively correlated with left ventricular ejection fraction (LVEF) in STEMI patients. The results indicate that circulating IL-38 is a potentially novel biomarker for patients with STEMI and IL-38 might be a new target for MI study.

  10. Association between Low Free Triiodothyronine Levels and Poor Prognosis in Patients with Acute ST-Elevation Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Yuanbin Song

    2018-01-01

    Full Text Available Background. Low free triiodothyronine (fT3 levels are generally associated with poor prognosis in patients with heart diseases, but this is controversial and there is a lack of data about ST-elevation myocardial infarction (STEMI in Chinese patients. Objective. To assess the association between fT3 levels and the prognosis of patients with STEMI. Methods. This was a prospective observational study of 699 consecutive patients with STEMI treated at the Xinqiao Hospital between January 1, 2013, and December 31, 2014. The patients were divided into the low fT3 (fT3 < 3.1 pmol/L; n=179, 27.5% and normal fT3 (fT3 ≥ 3.1 pmol/L; n=473, 72.5% groups according to fT3 levels at admission. Patients were followed up at 1, 3, 6, and 12 months for all-cause death and major adverse cardiac events (MACE. Results. During the 1-year follow-up, there were 70 all-cause deaths (39.1% in the low fT3 group and 40 (8.5% in the normal fT3 group (P<0.001. MACE occurred in 105 patients (58.7% in the low fT3 group and 74 (15.6% in the normal fT3 group (P<0.001. Multivariate Cox proportional hazards regression analysis indicated that fT3 levels were independently associated with 30-day and 1-year all-cause death [30-day: hazard ratio (HR = 0.702, 95% confidence interval (95% CI: 0.501–0.983, P=0.04; 1-year: HR = 0.557, 95% CI: 0.411–0.755, P<0.001] and MACE (30-day: HR = 0.719, 95% CI: 0.528–0.979, P=0.036; 1-year: HR = 0.557, 95% CI: 0.445–0.698, P<0.001. Conclusion. Low fT3 levels were strongly associated with poor prognosis in patients with STEMI. Measurement of fT3 levels may be a valuable and simple way to identify high-risk STEMI patients.

  11. Socially disadvantaged city districts show a higher incidence of acute ST-elevation myocardial infarctions with elevated cardiovascular risk factors and worse prognosis.

    Science.gov (United States)

    Schmucker, J; Seide, S; Wienbergen, H; Fiehn, E; Stehmeier, J; Günther, K; Ahrens, W; Hambrecht, R; Pohlabeln, H; Fach, A

    2017-09-22

    The importance of socioeconomic status (SES) for coronary heart disease (CHD)-morbidity is subject of ongoing scientific investigations. This study was to explore the association between SES in different city-districts of Bremen/Germany and incidence, severity, treatment modalities and prognosis for patients with ST-elevation myocardial infarctions (STEMI). Since 2006 all STEMI-patients from the metropolitan area of Bremen are documented in the Bremen STEMI-registry. Utilizing postal codes of their home address they were assigned to four groups in accordance to the Bremen social deprivation-index (G1: high, G2: intermediate high, G3: intermediate low, G4: low socioeconomic status). Three thousand four hundred sixty-two consecutive patients with STEMI admitted between 2006 and 2015 entered analysis. City areas with low SES showed higher adjusted STEMI-incidence-rates (IR-ratio 1.56, G4 vs. G1). This elevation could be observed in both sexes (women IRR 1.63, men IRR 1.54) and was most prominent in inhabitants  3000 U/l, OR 1.95, 95% CI 1.4-2.8) and severe impairment of LV-function post-STEMI (OR 2.0, 95% CI 1.2-3.4). Long term follow-up revealed that lower SES was associated with higher major adverse cardiac or cerebrovascular event (MACCE)-rates after 5 years: G1 30.8%, G2 35.7%, G3 36.0%, G4 41.1%, p (for trend) = 0.02. This worse prognosis could especially be shown for young STEMI-patients (<50 yrs. of age) 5-yr. mortality-rates(G4 vs. G1) 18.4 vs. 3.1%, p = 0.03 and 5-year-MACCE-rates (G4 vs. G1) 32 vs. 6.3%, p = 0.02. This registry-data confirms the negative association of low socioeconomic status and STEMI-incidence, with higher rates of smoking and obesity, more extensive infarctions and worse prognosis for the socio-economically deprived.

  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

    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...

  13. 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...

  14. 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

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

    NARCIS (Netherlands)

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

    2014-01-01

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

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

    NARCIS (Netherlands)

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

    2012-01-01

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

  17. 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.

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

    Science.gov (United States)

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

    2017-11-14

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

  19. 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

  20. 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

    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...

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

    International Nuclear Information System (INIS)

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

    2013-01-01

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

  2. Management and outcomes of acute ST-segment-elevation myocardial infarction at a tertiary-care hospital in Sri Lanka: an observational study.

    Science.gov (United States)

    Bandara, Ruwanthi; Medagama, Arjuna; Munasinghe, Ruwan; Dinamithra, Nandana; Subasinghe, Amila; Herath, Jayantha; Ratnayake, Mahesh; Imbulpitiya, Buddhini; Sulaiman, Ameena

    2015-01-15

    Sri Lanka is a developing country with a high rate of cardiovascular mortality. It is still largely dependent on thrombolysis for primary management of acute myocardial infarction. The aim of this study was to present current data on the presentation, management, and outcomes of acute ST-segment-elevation myocardial infarction (STEMI) at a tertiary-care hospital in Sri Lanka. Eighty-one patients with acute STEMI presenting to a teaching hospital in Peradeniya, Sri Lanka, were included in this observational study. Median interval between symptom onset and hospital presentation was 60 min (mean 212 min). Thrombolysis was performed in 73% of patients. The most common single reason for not performing thrombolysis was delayed presentation. Median door-to-needle time was 64 min (mean, 98 min). Only 16.9% of patients received thrombolysis within 30 min, and none underwent primary PCI. Over 98% of patients received aspirin, clopidogrel, and a statin on admission. Intravenous and oral beta blockers were rarely used. Follow-up data were available for 93.8% of patients at 1 year. One-year mortality rate was 12.3%. Coronary intervention was performed in only 7.3% of patients post infarction. Late presentation to hospital remains a critical factor in thrombolysis of STEMI patients in Sri Lanka. Thrombolysis was not performed within 30 min of admission in the majority of patients. First-contact physicians should receive further training on effective thrombolysis, and there is an urgent need to explore the ways in which PCI and post-infarction interventions can be incorporated into treatment protocols.

  3. Pulmonary embolism presenting with ST segment elevation in inferior leads

    Directory of Open Access Journals (Sweden)

    Muzaffer Kahyaoğlu

    2017-03-01

    Full Text Available Acute pulmonary embolism is a form of venous thromboembolism that is widespread and sometimes mortal. The clinical presentation of pulmonary embolism is variable and often nonspecific making the diagnosis challenging. In this report, we present a case of pulmonary embolism characterized by ST segment elevation in inferior leads without reciprocal changes in the electrocardiogram.

  4. 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.

  5. MR-proADM as a Prognostic Marker in Patients With ST-Segment-Elevation Myocardial Infarction-DANAMI-3 (a Danish Study of Optimal Acute Treatment of Patients With STEMI) Substudy

    DEFF Research Database (Denmark)

    Falkentoft, Alexander C; Rørth, Rasmus; Iversen, Kasper

    2018-01-01

    BACKGROUND: Midregional proadrenomedullin (MR-proADM) has demonstrated prognostic potential after myocardial infarction (MI). Yet, the prognostic value of MR-proADM at admission has not been examined in patients with ST-segment-elevation MI (STEMI). METHODS AND RESULTS: The aim of this substudy......, DANAMI-3 (The Danish Study of Optimal Acute Treatment of Patients with ST-segment-elevation myocardial infarction), was to examine the associations of admission concentrations of MR-proADM with short- and long-term mortality and hospital admission for heart failure in patients with ST......-segment-elevation myocardial infarction. Outcomes were assessed using Cox proportional hazard models and area under the curve using receiver operating characteristics. In total, 1122 patients were included. The median concentration of MR-proADM was 0.64 nmol/L (25th-75th percentiles, 0.53-0.79). Within 30 days 23 patients (2...

  6. [Atorvastatin improves reflow after percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction by decreasing serum uric acid level].

    Science.gov (United States)

    Yan, Ling; Ye, Lu; Wang, Kun; Zhou, Jie; Zhu, Chunjia

    2016-05-25

    Objective: To investigate the effect of atorvastatin on reflow in patients with acute ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) and its relation to serum uric acid levels. Methods: One hundred and fourteen STEMI patients undergoing primary PCI were enrolled and randomly divided into two groups:55 cases received oral atorvastatin 20 mg before PCI (routine dose group) and 59 cases received oral atorvastatin 80 mg before PCI (high dose group). According to the initial serum uric acid level, patients in two groups were further divided into normal uric acid subgroup and hyperuricemia subgroup. The changes of uric acid level and coronary artery blood flow after PCI were observed. Correlations between the decrease of uric acid, the dose of atorvastatin and the blood flow of coronary artery after PCI were analyzed. Results: Serum uric acid levels were decreased after treatment in both groups (all P uric acid level ( P uric acid level in patients with hyperuricemia decreased more significantly in the high dose group ( P uric acid levels in two groups ( P >0.05). Among 114 patients, there were 19 cases without reflow after PCI (16.7%). In the routine dose group, there were 12 patients without reflow, in which 3 had normal uric acid and 9 had high uric acid levels ( P uric acid and 5 had high uric acid ( P uric acid levels and improve reflow after PCI in patients with STEMI.

  7. 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.

  8. Alteration of Multiple Leukocyte Gene Expression Networks is Linked with Magnetic Resonance Markers of Prognosis After Acute ST-Elevation Myocardial Infarction.

    Science.gov (United States)

    Teren, A; Kirsten, H; Beutner, F; Scholz, M; Holdt, L M; Teupser, D; Gutberlet, M; Thiery, J; Schuler, G; Eitel, I

    2017-02-03

    Prognostic relevant pathways of leukocyte involvement in human myocardial ischemic-reperfusion injury are largely unknown. We enrolled 136 patients with ST-elevation myocardial infarction (STEMI) after primary angioplasty within 12 h after onset of symptoms. Following reperfusion, whole blood was collected within a median time interval of 20 h (interquartile range: 15-25 h) for genome-wide gene expression analysis. Subsequent CMR scans were performed using a standard protocol to determine infarct size (IS), area at risk (AAR), myocardial salvage index (MSI) and the extent of late microvascular obstruction (lateMO). We found 398 genes associated with lateMO and two genes with IS. Neither AAR, nor MSI showed significant correlations with gene expression. Genes correlating with lateMO were strongly related to several canonical pathways, including positive regulation of T-cell activation (p = 3.44 × 10 -5 ), and regulation of inflammatory response (p = 1.86 × 10 -3 ). Network analysis of multiple gene expression alterations associated with larger lateMO identified the following functional consequences: facilitated utilisation and decreased concentration of free fatty acid, repressed cell differentiation, enhanced phagocyte movement, increased cell death, vascular disease and compensatory vasculogenesis. In conclusion, the extent of lateMO after acute, reperfused STEMI correlated with altered activation of multiple genes related to fatty acid utilisation, lymphocyte differentiation, phagocyte mobilisation, cell survival, and vascular dysfunction.

  9. Comparison between second and third generation troponin T assay in patients with symptoms suggestive of an acute coronary syndrome but without ST segment elevation.

    Science.gov (United States)

    Jernberg, Tomas; Venge, Per; Lindahl, Bertil

    2003-01-01

    Cardiac troponin T (cTnT) is a useful tool when assessing patients with chest pain and no persistent ST elevation. We compared the 2nd generation with the new, 3rd generation cTnT assay in 750 patients admitted to our coronary care unit because of chest pain. When focusing on patients with cTnT of 0.01-0.20 microg/l, there was a moderate agreement between the methods. According to recent definitions, 35% more patients were classified as having acute myocardial infarction on admission with the 3rd generation assay. The 3rd generation assay also identified a 10% larger low-risk group and was better able to identify patients with signs of very minor myocardial necrosis (cTnT >0.01-0.02 microg/l) and thereby an increased risk of future events. We conclude that the improved precision of the 3rd generation assay does have some clinical implications in terms of improved accuracy of triage and improved prognostic value. Copyright 2003 S. Karger AG, Basel

  10. Use and outcome of radial versus femoral approach for primary PCI in patients with acute ST elevation myocardial infarction without cardiogenic shock: results from the ALKK PCI registry.

    Science.gov (United States)

    Bauer, Timm; Hochadel, Matthias; Brachmann, Johannes; Schächinger, Volker; Boekstegers, Peter; Zrenner, Bernhard; Zahn, Ralf; Zeymer, Uwe

    2015-10-01

    This study sought to compare the use and outcome of radial versus femoral access in patients treated with primary percutaneous coronary intervention (PCI) for acute ST elevation myocardial infarction (STEMI) in clinical practice. The radial approach for PCI in patients with STEMI has been suggested to have a lower rate of complications and bleeding and to improve prognosis compared with the femoral approach. However, there still is a large regional and national variation in its use. Between 2008 and 2012 a total of 17,865 patients with STEMI without cardiogenic shock undergoing primary PCI were prospectively enrolled in the observational German PCI registry of the Arbeitsgemeinschaft leitende kardiologische Krankenhausärzte (ALKK). Transfemoral (TF) access was used in 15,270 (85.5%), transradial (TR) access in 2,530 (14.2%), and other access in 65 (0.3%) patients. In this analysis, 10,264 patients from 20 centers that had performed at least 5 TR-PCI for STEMI were included. This study compared TR-PCI (n = 2,454 23.9%) with TF-PCI (n = 7,810, 76.1%). Procedural success was high in both cohorts. Hospital mortality (1.8 vs. 5.1%, P PCI can be performed with excellent procedural success in selected STEMI patients and is associated with a lower rate of vascular access complications and hospital mortality. © 2015 Wiley Periodicals, Inc.

  11. Intracoronary versus Intravenous eptifibatide during percutaneous coronary intervention for acute ST-segment elevation myocardial infarction; a randomized controlled trial.

    Science.gov (United States)

    Sanati, Hamid Reza; Zahedmehr, Ali; Firouzi, Ata; Farrashi, Melody; Amin, Kamyar; Peighambari, Mohammad Mehdi; Shakerian, Farshad; Kiani, Reza

    2017-10-01

    Although aspirin and clopidogrel seem to be quite enough during low risk percutaneous coronary intervention (PCI), the combination may need some reinforcement in complex situations such as primary PCI. By modifying the route and also the duration of administration, glycoprotein IIb/IIIa inhibitors might be a viable option. The aim of this study is to compare the benefits and disadvantages of three different methods of administration of eptifibatide in primary PCI population. Primary PCI candidates were randomized in three groups on which three different methods of administration of eptifibitide were tested: intravenous bolus injection followed by 12-h infusion (IV-IV), intracoronary bolus injection followed by intravenous infusion (IC-IV) and, only intracoronary bolus injection (IC). 99 patients were included in the present study. There was no significant difference among the three groups regarding all cause in hospital and one month mortality (p value = 0.99), re-myocardial infarction (p value = 0.89), post-PCI TIMI flow grade 3 (p value = 0.97), ST segment resolution (p value = 0.77) and peak troponin levels (p value = 0.82). The comparison of vascular access and major bleeding complications were not possible due to low events rate. By modifying the route of administration of eptifibitide, the clinical effect might be preserved without increasing the short-term mortality and procedural failure.

  12. Use and impact of thrombectomy in primary percutaneous coronary intervention for acute myocardial infarction with persistent ST-segment elevation: results of the prospective ALKK PCI-registry.

    Science.gov (United States)

    Härle, Tobias; Zeymer, Uwe; Hochadel, Matthias; Schmidt, Karin; Zahn, Ralf; Darius, Harald; Behrens, Steffen; Lauer, Bernward; Mudra, Harald; Schächinger, Volker; Elsässer, Albrecht

    2015-10-01

    Data about the impact of thrombectomy in primary percutaneous coronary intervention (PCI) are inconsistent. The aim of our study was an evaluation of both the real-world use of thrombectomy and the impact of thrombectomy on outcome in unselected patients treated with primary PCI for ST-elevation myocardial infarction (STEMI). We used the data of the prospective ALKK PCI-registry of 35 hospitals from January 2010 to December 2013. A total of 10,755 patients receiving single-vessel primary PCI for acute STEMI were included. In 2176 patients (20.2 %) thrombectomy was performed. There was a wide range of use of thrombectomy in the different ALKK hospitals from 1.1 to 61.7 % (median 18.6 %, quartiles 6.0 and 40.3 %) with a general increase of use over the first years of the study period. In patients with and without thrombectomy there was TIMI 0 flow present before PCI in 6010 patients, TIMI 1 in 1338, TIMI 2 in 2002, and TIMI 3 in 1405. Patients with acute heart failure or cardiogenic shock received significantly more often thrombectomy. Fluoroscopy time (8.1 vs. 7.3 min, p PCI had significantly higher rates of TIMI 3 flow after PCI when treated with thrombectomy (87.1 vs. 84.1 %, p PCI TIMI 3 flow in patients with TIMI 1, 2 or 3 flow before PCI. Rates of major adverse cardiac and cerebrovascular events were similar in both groups in general and in all subgroups of TIMI flow. The use of thrombectomy in patients with STEMI is heterogenous between hospitals. Overall, there was no impact of thrombectomy on TIMI 3 patency or mortality after PCI. In the subgroup of STEMI patients with TIMI 0 flow before PCI individualized thrombectomy had a positive impact on restoration of normal blood flow.

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

    Science.gov (United States)

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

    2017-10-01

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

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

    Science.gov (United States)

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

    2017-08-19

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

  15. Cost-effectiveness of alternative strategies for the initial medical management of non-ST elevation acute coronary syndrome: systematic review and decision-analytical modelling.

    Science.gov (United States)

    Robinson, M; Palmer, S; Sculpher, M; Philips, Z; Ginnelly, L; Bowens, A; Golder, S; Alfakih, K; Bakhai, A; Packham, C; Cooper, N; Abrams, K; Eastwood, A; Pearman, A; Flather, M; Gray, D; Hall, A

    2005-07-01

    To identify and prioritise key areas of clinical uncertainty regarding the medical management of non-ST elevation acute coronary syndrome (ACS) in current UK practice. Electronic databases. Consultations with clinical advisors. Postal survey of cardiologists. Potential areas of important uncertainty were identified and 'decision problems' prioritised. A systematic literature review was carried out using standard methods. The constructed decision model consisted of a short-term phase that applied the results of the systematic review and a long-term phase that included relevant information from a UK observational study to extrapolate estimated costs and effects. Sensitivity analyses were undertaken to examine the dependence of the results on baseline parameters, using alternative data sources. Expected value of information analysis was undertaken to estimate the expected value of perfect information associated with the decision problem. This provided an upper bound on the monetary value associated with additional research in the area. Seven current areas of clinical uncertainty (decision problems) in the drug treatment of unstable angina patients were identified. The agents concerned were clopidogrel, low molecular weight heparin, hirudin and intravenous glycoprotein antagonists (GPAs). Twelve published clinical guidelines for unstable angina or non-ST elevation ACS were identified, but few contained recommendations about the specified decision problems. The postal survey of clinicians showed that the greatest disagreement existed for the use of small molecule GPAs, and the greatest uncertainty existed for decisions relating to the use of abciximab (a large molecule GPA). Overall, decision problems concerning the GPA class of drugs were considered to be the highest priority for further study. Selected papers describing the clinical efficacy of treatment were divided into three groups, each representing an alternative strategy. The strategy involving the use of GPAs

  16. Impact of mobile intensive care unit use on total ischemic time and clinical outcomes in ST-elevation myocardial infarction patients - real-world data from the Acute Coronary Syndrome Israeli Survey.

    Science.gov (United States)

    Koifman, Edward; Beigel, Roy; Iakobishvili, Zaza; Shlomo, Nir; Biton, Yitschak; Sabbag, Avi; Asher, Elad; Atar, Shaul; Gottlieb, Shmuel; Alcalai, Ronny; Zahger, Doron; Segev, Amit; Goldenberg, Ilan; Strugo, Rafael; Matetzky, Shlomi

    2017-01-01

    Ischemic time has prognostic importance in ST-elevation myocardial infarction patients. Mobile intensive care unit use can reduce components of total ischemic time by appropriate triage of ST-elevation myocardial infarction patients. Data from the Acute Coronary Survey in Israel registry 2000-2010 were analyzed to evaluate factors associated with mobile intensive care unit use and its impact on total ischemic time and patient outcomes. The study comprised 5474 ST-elevation myocardial infarction patients enrolled in the Acute Coronary Survey in Israel registry, of whom 46% ( n=2538) arrived via mobile intensive care units. There was a significant increase in rates of mobile intensive care unit utilization from 36% in 2000 to over 50% in 2010 ( pcare unit use were Killip>1 (odds ratio=1.32, pcare units benefitted from increased rates of primary reperfusion therapy (odds ratio=1.58, pcare unit benefitted from shorter median total ischemic time compared with non-mobile intensive care unit patients (175 (interquartile range 120-262) vs 195 (interquartile range 130-333) min, respectively ( pcare unit use was the most important predictor in achieving door-to-balloon time care unit group (odds ratio=0.79, 95% confidence interval (0.66-0.94), p=0.01). Among patients with ST-elevation myocardial infarction, the utilization of mobile intensive care units is associated with increased rates of primary reperfusion, a reduction in the time interval to reperfusion, and a reduction in one-year adjusted mortality.

  17. Randomized Comparison of Primary Percutaneous Coronary Intervention With Combined Proximal Embolic Protection and Thrombus Aspiration Versus Primary Percutaneous Coronary Intervention Alone in ST-Segment Elevation Myocardial Infarction The PREPARE (PRoximal Embolic Protection in Acute myocardial infarction and Resolution of ST-Elevation) Study

    NARCIS (Netherlands)

    Haeck, Joost D. E.; Koch, Karel T.; Bilodeau, Luc; van der Schaaf, René J.; Henriques, José P. S.; Vis, Marije M.; Baan, Jan; van der Wal, Allard C.; Piek, Jan J.; Tijssen, Jan G. P.; Krucoff, Mitchell W.; de Winter, Robbert J.

    2009-01-01

    Objectives The purpose of this study was to evaluate the effectiveness of combined proximal embolic protection with thrombus aspiration (Proxis Embolic Protection System [St. Jude Medical, St. Paul, Minnesota]) in ST-segment elevation myocardial infarction patients. Background Embolization during

  18. Incidence and Significance of Spontaneous ST Segment Re-elevation After Reperfused Anterior Acute Myocardial Infarction - Relationship With Infarct Size, Adverse Remodeling, and Events at 1 Year.

    Science.gov (United States)

    Cuenin, Léo; Lamoureux, Sophie; Schaaf, Mathieu; Bochaton, Thomas; Monassier, Jean-Pierre; Claeys, Marc J; Rioufol, Gilles; Finet, Gérard; Garcia-Dorado, David; Angoulvant, Denis; Elbaz, Meyer; Delarche, Nicolas; Coste, Pierre; Metge, Marc; Perret, Thibault; Motreff, Pascal; Bonnefoy-Cudraz, Eric; Vanzetto, Gérald; Morel, Olivier; Boussaha, Inesse; Ovize, Michel; Mewton, Nathan

    2018-04-25

    Up to 25% of patients with ST elevation myocardial infarction (STEMI) have ST segment re-elevation after initial regression post-reperfusion and there are few data regarding its prognostic significance.Methods and Results:A standard 12-lead electrocardiogram (ECG) was recorded in 662 patients with anterior STEMI referred for primary percutaneous coronary intervention (PPCI). ECGs were recorded 60-90 min after PPCI and at discharge. ST segment re-elevation was defined as a ≥0.1-mV increase in STMax between the post-PPCI and discharge ECGs. Infarct size (assessed as creatine kinase [CK] peak), echocardiography at baseline and follow-up, and all-cause death and heart failure events at 1 year were assessed. In all, 128 patients (19%) had ST segment re-elevation. There was no difference between patients with and without re-elevation in infarct size (CK peak [mean±SD] 4,231±2,656 vs. 3,993±2,819 IU/L; P=0.402), left ventricular (LV) ejection fraction (50.7±11.6% vs. 52.2±10.8%; P=0.186), LV adverse remodeling (20.1±38.9% vs. 18.3±30.9%; P=0.631), or all-cause mortality and heart failure events (22 [19.8%] vs. 106 [19.2%]; P=0.887) at 1 year. Among anterior STEMI patients treated by PPCI, ST segment re-elevation was present in 19% and was not associated with increased infarct size or major adverse events at 1 year.

  19. 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

  20. Clinical presentation, Quality of care, Risk factors and Outcomes in Women with Acute ST-Elevation Myocardial Infarction (STEMI): An Observational Report from Six Middle Eastern Countries.

    Science.gov (United States)

    Shehab, Abdulla; AlHabib, Khalid F; Bhagavathula, Akshaya Srikanth; Hersi, Ahmad; Alfaleh, Hussam; Alshamiri, Mostafa Q; Ullah, Anhar; Sulaiman, Khadim; Almahmeed, Wael; Al Suwaidi, Jassim; Alsheikh-Ali, Alwai A; Amin, Haitham; Al Jarallah, Mohammed; Salam, Amar M

    2018-03-14

    Most of the available literature on ST-Elevated myocardial infarction (STEMI) in women was conducted in the developed world and data from Middle-East countries was limited. To examine the clinical presentation, patient management, quality of care, risk factors and in-hospital outcomes of women with acute STEMI compared with men using data from a large STEMI registry from the Middle East. Data were derived from the third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps), a prospective, multinational study of adults with acute STEMI from 36 hospitals in 6 Middle-Eastern countries. The study included 2928 patients; 296 women (10.1%) and 2632 men (89.9%). Clinical presentations, management and in-hospital outcomes were compared between the 2 groups. Women were 10 years older and more likely to have diabetes mellitus, hypertension, and hyperlipidemia compared with men who were more likely to be smokers (all p<0.001). Women had longer median symptom-onset to emergency department (ED) arrival times (230 vs. 170 min, p<0.001) and ED to diagnostic ECG (8 vs. 6 min., p<0.001). When primary percutaneous coronary intervention (PPCI) was performed, women had longer door-to-balloon time (DBT) (86 vs. 73 min., p=0.009). When thrombolytic therapy was not administered, women were less likely to receive PPCI (69.7 vs. 76.7%, p=0.036). The mean duration of hospital stay was longer in women (6.03 ± 22.51 vs. 3.41 ± 19.45 days, p=0.032) and the crude in-hospital mortality rate was higher in women (10.4 vs. 5.2%, p<0.001). However, after adjustments, multivariate analysis revealed a statistically non-significant trend of higher in-hospital mortality among women than men (6.4 vs. 4.6%), (p=0.145). Our study demonstrates that women in our region have almost double the mortality from STEMI compared with men. Although this can partially be explained by older age and higher risk profiles in women, however, correction of identified gaps in quality of care should be attempted to reduce

  1. Relationships of elevated systemic pentraxin-3 levels with high-risk coronary plaque components and impaired myocardial perfusion after percutaneous coronary intervention in patients with ST-elevation acute myocardial infarction.

    Science.gov (United States)

    Kimura, Shigeki; Inagaki, Hiroshi; Haraguchi, Go; Sugiyama, Tomoyo; Miyazaki, Toru; Hatano, Yu; Yoshikawa, Shunji; Ashikaga, Takashi; Isobe, Mitsuaki

    2014-01-01

    We aimed to assess the relationships of pentraxin-3 (PTX3) with coronary plaque components and myocardial perfusion after percutaneous coronary intervention (PCI) in order to clarify the mechanisms underlying the prognostic function of PTX3 in ST-elevation acute myocardial infarction (STEMI) patients. We enrolled 75 STEMI patients who underwent pre-PCI virtual histology (VH)-intravascular ultrasound. Relationships of the systemic pre-PCI PTX3 level with coronary plaque components and post-PCI myocardial blush grade (MBG) were evaluated. Lesions with elevated pre-PCI PTX3 (median ≥3.79ng/ml) had higher frequencies of VH-derived thin-cap fibroatheroma (65.8% vs. 24.3%, P2 on admission (hazard ratio, 5.356; 95% CI, 1.409-20.359; P=0.014) as independent predictors of adverse cardiac events during follow-up. Systemic pre-PCI PTX3 was associated with high-risk plaque components and impaired post-PCI myocardial perfusion. Thus, PTX3 may be a reliable predictor of outcome in STEMI patients.

  2. Long-term survival and causes of death in patients with ST-elevation acute coronary syndrome without obstructive coronary artery disease.

    Science.gov (United States)

    Andersson, Hedvig Bille; Pedersen, Frants; Engstrøm, Thomas; Helqvist, Steffen; Jensen, Morten Kvistholm; Jørgensen, Erik; Kelbæk, Henning; Räder, Sune Bernd Emil Werner; Saunamäki, Kari; Bates, Eric; Grande, Peer; Holmvang, Lene; Clemmensen, Peter

    2018-01-07

    We aimed to study survival and causes of death in patients with ST-elevation acute coronary syndrome (STE-ACS) with and without obstructive coronary artery disease (CAD). We included 4793 consecutive patients with STE-ACS triaged for acute coronary angiography at a large cardiac invasive centre (2009-2014). Of these, 88% had obstructive CAD (stenosis ≥50%), 6% had non-obstructive CAD (stenosis 1-49%), and 5% had normal coronary arteries. Patients without obstructive CAD were younger and more often female with fewer cardiovascular risk factors. Median follow-up time was 2.6 years. Compared with patients with obstructive CAD, the short-term hazard of death (≤30 days) was lower in both patients with non-obstructive CAD [hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.27-0.89, P = 0.018] and normal coronary arteries (HR 0.31, 95% CI 0.11-0.83, P = 0.021). In contrast, the long-term hazard of death (>30 days) was similar in patients with non-obstructive CAD (HR 1.15, 95% CI 0.77-1.72, P = 0.487) and higher in patients with normal coronary arteries (HR 2.44, 95% CI 1.58-3.76, P Causes of death were cardiovascular in 70% of patients with obstructive CAD, 38% with non-obstructive CAD, and 32% with normal coronary arteries. Finally, patients without obstructive CAD had lower survival compared with an age and sex matched general population. STE-ACS patients without obstructive CAD had a long-term risk of death similar to or higher than patients with obstructive CAD. Causes of death were less often cardiovascular. This suggests that STE-ACS patients without obstructive CAD warrant medical attention and close follow-up. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

  3. Evaluation of related factors, prediction and treatment drugs of no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction after direct PCI.

    Science.gov (United States)

    Li, Hui; Fu, Du-Guan; Liu, Fu-Yuan; Zhou, Heng; Li, Xiao-Mei

    2018-04-01

    This study determined the related factors of no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction (STEMI) after direct percutaneous coronary intervention (PCI), and evaluated related factor scores in predicting the occurrence of no-reflow phenomenon and drug treatments. A total of 203 patients with acute STEMI receiving PCI who were admitted to the Department of Cardiovascularology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine (Xiangyang, China) from January 2015 to December 2016 were selected. The clinical and image data were analyzed to determine the related factors of no-reflow phenomenon after operation, and related factor scores were quantified to predict the occurrence of no-reflow phenomenon. Three drugs (diltiazem, nitroglycerin and tirofiban needles) were continuously injected in coronary arteries of patients with no-reflow phenomenon, and the effects of these drugs were analyzed. There were 38 patients (18.7%) with no-reflow phenomenon. The correlation analysis showed that 10 factors were associated with no-reflow phenomenon, in which five factors were identified as risk factors, including IRA open-up time ≥8 h, SBP 18 mg/l, thrombus loads, length of the culprit vessel ≥20 mm. The score analysis of related factors of 38 patients with no-reflow phenomenon was conducted. Three points were set for five risk factors each, and 1 point was set for the other five factors each. It was found that the score was approximately normally distributed. The average was 11.5±1.57 points and the lower limit of 95% confidence interval was >8.93 points. The effective rates of three drugs were different (P<0.05), and the pairwise comparison showed their effective rates were not fully identical (P<0.05). The results showed that: i) Τhere are 10 related factors, including five risk factors; ii) related factors with the score ≥9 points can be used for clinical prediction of STEMI after direct PCI; and iii) it is

  4. Prognostic implications of high-sensitivity cardiac troponin T assay in a real-world population with non-ST-elevation acute coronary syndrome.

    Science.gov (United States)

    Magnoni, Marco; Gallone, Guglielmo; Ceriotti, Ferruccio; Vergani, Vittoria; Giorgio, Daniela; Angeloni, Giulia; Maseri, Attilio; Cianflone, Domenico

    2018-09-01

    High-sensitivity cardiac troponin T (hsTnT) was recently approved for clinical use by the Food and Drug Administration. The transition from contemporary to hsTnT assays requires a thorough understanding of the clinical differences between these assays. HsTnT may provide a more accurate prognostic stratification than contemporary cardiac troponin I (cTnI) in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). HsTnT and cTnI were measured in 644 patients with CK-MB negative NSTE-ACS who were enrolled in the prospective multicenter SPAI (Stratificazione Prognostica dell'Angina Instabile) study. Patients were stratified at the 99th percentile reference limit for each assay. The primary endpoint was cardiovascular death (CVD) or non-fatal myocardial infarction (MI); the secondary endpoint was the occurrence of unstable angina (UA). Follow-up lasted 180 days. Patients with hsTnT ≥99th percentile were at higher risk of CVD/MI (30-day: 5.9% vs 0.8%, p  = 0.001; 180-day: 11.1% vs 4.7%, p  = 0.004), also after adjusting for TIMI Risk Score. No significant difference in CVD/MI at 180-day was found between hsTnT-positive/cTnI-negative and hsTnT-negative/cTnI-negative patients (adjHR 1.61, 95% CI 0.74-3.49, p  = 0.232). Occurrence of UA was not differently distributed between hsTnT groups dichotomized at the 99th percentile (12.4% vs 12.5% p  = 0.54). Our investigation on a real-world NSTE-ACS population showed good prognostic performance of hsTnT in the risk stratification of the hard endpoint, but did not demonstrate the improved prognostic ability of hsTnT over contemporary cTn. Neither troponin assay predicted the recurrence of UA, suggesting the acute rise of cardiac troponin as a marker of severity, but not the occurrence of future coronary instability.

  5. Effect of postprocedural full-dose infusion of bivalirudin on acute stent thrombosis in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: Outcomes in a large real-world population.

    Science.gov (United States)

    Wang, Heyang; Liang, Zhenyang; Li, Yi; Li, Bin; Liu, Junming; Hong, Xueyi; Lu, Xin; Wu, Jiansheng; Zhao, Wei; Liu, Qiang; An, Jian; Li, Linfeng; Pu, Fanli; Ming, Qiang; Han, Yaling

    2017-06-01

    This study aimed to evaluate the effect of prolonged full-dose bivalirudin infusion in real-world population with ST-elevation myocardial infarction (STEMI). Subgroup data as well as meta-analysis from randomized clinical trials have shown the potency of postprocedural full-dose infusion (1.75 mg/kg/h) of bivalirudin on attenuating acute stent thrombosis (ST) after primary percutaneous coronary intervention (PCI). In this multicenter retrospective observational study, 2047 consecutive STEMI patients treated with bivalirudin during primary PCI were enrolled in 65 Chinese centers between July 2013 and May 2016. The primary outcome was acute ST defined as ARC definite/probable within 24 hours after the index procedure, and the secondary endpoints included total ST, major adverse cardiac or cerebral events (MACCE, defined as death, reinfarction, stroke, and target vessel revascularization), and any bleeding at 30 days. Among 2047 STEMI patients, 1123 (54.9%) were treated with postprocedural bivalirudin full-dose infusion (median 120 minutes) while the other 924 (45.1%) received low-dose (0.25 mg/kg/h) or null postprocedural infusion. A total of three acute ST (0.3%) occurred in STEMI patients with none or low-dose prolonged infusion of bivalirudin, but none was observed in those treated with post-PCI full-dose infusion (0.3% vs 0.0%, P=.092). Outcomes on MACCE (2.1% vs 2.7%, P=.402) and total bleeding (2.1% vs 1.4%, P=.217) at 30 days showed no significant difference between the two groups, and no subacute ST was observed. Post-PCI full-dose bivalirudin infusion is safe and has a trend to protect against acute ST in STEMI patients undergoing primary PCI in real-world settings. © 2017 John Wiley & Sons Ltd.

  6. 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.

  7. 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 impact of pre-hospital diagnosis on time from emergency medical services contact to balloon inflation (system delay) in an unselected cohort of patients with STEMI recruited from a large geographical area comprising both urban and rural districts....

  8. [Prognostic factors in patients with non-ST-segment elevation acute coronary syndrome concurrent with type 2 diabetes mellitus (according to the results of the registry)].

    Science.gov (United States)

    Golikov, A P; Berns, S A; Stryuk, R I; Shmidt, E A; Golikova, A A; Barbarash, O L

    To investigate factors that influence annual prognosis in patients with non-ST-segment elevation acute coronary syndrome ((NSTEACS) concurrent with type 2 diabetes mellitus (DM2). The registry of patients with NSTEACS (non-ST-segment elevation myocardial infarction (NSTEMI), unstable angina) included 415 patients, of them 335 had no carbohydrate metabolic disorders, 80 had DM2. The follow-up period, during which the prognosis was evaluated in the patients, was one year after hospital discharge following the index NSTEACS event. Lipidogram readings and the serum levels of endothelin-1 (ET-1), sP-selectin, sE-selectin, and sPECAM were determined on day 10 after admission to hospital. All the patients underwent coronary angiography (CA), Doppler ultrasound of peripheral arteries during their hospital stay. The patients with DM2 versus those without diabetes proved to be significantly older and to have a higher body mass index; among them there were more women, they were noted to have more frequently hypertension and less frequently smoked. The presence of DM2 was associated with significantly increased intima-media thickness and higher GRACE scores (p=0.013) as compared to those in the patients with normal carbohydrate metabolism. There were significant differences in high-density lipoprotein levels that were lower, as well as in triglyceride levels and atherogenic index, which were higher in patients with DM2 than in those without this condition. In addition, there were significant differences in ET-1, sP-selectin, sE-selectin, and sPECAM levels that were significantly higher in the DM2 group. Moreover, the levels of ET-1 and sPECAM were above normal in both the DM and non-DM2 groups. Assessment of poor outcomes at one year of the observation established that cardiovascular mortality rates were significantly higher and coronary angiography was performed much less frequently in the DM2 group. The most significant prognostic factors associated with a poor prognosis

  9. Heparin monotherapy or bivalirudin during percutaneous coronary intervention in patients with non-ST-segment-elevation acute coronary syndromes or stable ischemic heart disease: results from the Evaluation of Drug-Eluting Stents and Ischemic Events registry.

    Science.gov (United States)

    Bangalore, Sripal; Pencina, Michael J; Kleiman, Neal S; Cohen, David J

    2014-06-01

    The use of bivalirudin versus unfractionated heparin monotherapy in patients without ST-segment-elevation myocardial infarction is not well defined. The study population consisted of patients enrolled in the Evaluation of Drug-Eluting Stents and Ischemic Events (EVENT) registry with either non-ST-segment-elevation acute coronary syndromes or stable ischemic heart disease, who underwent percutaneous coronary intervention with either unfractionated heparin or bivalirudin monotherapy. Propensity score matching was used to adjust for baseline characteristics. The primary bleeding (in-hospital composite bleeding-access site bleeding, thrombolysis in myocardial infarction major/minor bleeding, or transfusion) and primary (in-hospital death/myocardial infarction) and secondary ischemic outcomes (death/myocardial infarction/unplanned repeat revascularization at 12 months) were evaluated. Propensity score matching yielded 1036 patients with non-ST-segment-elevation acute coronary syndromes and 2062 patients with stable ischemic heart disease. For the non-ST-segment-elevation acute coronary syndrome cohort, bivalirudin use was associated with lower bleeding (difference, -3.3% [-0.8% to -5.8%]; P=0.01; number need to treat=30) without increase in either primary (difference, 1.2% [4.1% to -1.8%]; P=0.45) or secondary ischemic outcomes, including stent thrombosis (difference, 0.0% [1.3% to -1.3%]; P=1.00). Similarly, in the stable ischemic heart disease cohort, bivalirudin use was associated with lower bleeding (difference, -1.8% [-0.4% to -3.3%]; P=0.01; number need to treat=53) without increase in either primary (difference, 0.4% [2.3% to -1.5%]; P=0.70) or secondary ischemic outcomes, including stent thrombosis (difference, 0.0% [0.7% to -0.7%]; P=1.00) when compared with unfractionated heparin monotherapy. Among patients with non-ST-segment-elevation acute coronary syndromes or stable ischemic heart disease undergoing percutaneous coronary intervention, bivalirudin use

  10. Meteorological Parameters and the Onset of Chest Pain in Subjects with Acute ST-Elevation Myocardial Infarction: an Eight-Year, Single-Center Study in China

    Directory of Open Access Journals (Sweden)

    En-Zhi Jia

    2014-10-01

    Full Text Available Objective: The purpose of this study was to investigate the influence of weather on the occurrence of acute ST-elevation myocardial infarction in Chinese subjects. Methods: Weather and climate data, as well as the occurrence of STEMI, were monitored at 2 am, 8 am, 2 pm, and 8 pm between 2003 and 2010. Generalized additive Poisson models were utilized to plot the numbers of patients with STEMI within 6 hour intervals against climatological variations, after accounting for the effects of the hour and season. Results: The inclusion of meteorological conditions, including observed atmospheric pressure (hPa, hectopascal variations during the previous three hours and temperature (°C, degrees Celsius, significantly affected the occurrence of STEMI, as measured every six hours. Compared with the 50th percentile of atmospheric pressure variations, the RRs (95% CI for the first percentile, 10th percentile, 25th percentile, 75th percentile, 90th percentile, and 99th percentile of atmospheric pressure variation over lag 0 were 1.66 (1.36∼2.03, 1.47 (1.30∼1.67, 1.22 (1.12∼1.33, 1.16 (1.07∼1.25, 1.27 (1.13∼1.43, and 1.16 (0.92∼1.46, respectively. Compared to the 50th percentile of temperature, the RRs (95% CI for the first percentile, 10th percentile, 25th percentile, 75th percentile, 90th percentile, and 99th percentile of temperature over lag 0 were 0.58 (0.40∼0.83, 0.60 (0.46∼0.78, 0.69 (0.57∼0.83, 1.33 (1.14∼1.56, 1.39 (1.13∼1.71, and 1.17 (0.84∼1.63, respectively. Conclusions: Based on the eight-year, single-center study, significant relationships were observed among the occurrence of STEMI and atmospheric pressure variations during the previous three hours and temperature after account for long-term time trends.

  11. Effect of a hydrophilic and a hydrophobic statin on cardiac salvage after ST-elevated acute myocardial infarction - a pilot study.

    Science.gov (United States)

    Chitose, Tadasuke; Sugiyama, Seigo; Sakamoto, Kenji; Shimomura, Hideki; Yamashita, Takuro; Hokamaki, Jun; Tsunoda, Ryusuke; Shiraishi, Shinya; Yamashita, Yasuyuki; Ogawa, Hisao

    2014-11-01

    Early statin therapy after acute coronary syndrome reduces atherothrombotic vascular events. This study aimed to compare the effects of hydrophilic and hydrophobic statins on myocardial salvage and left ventricular (LV) function in patients with ST-elevated myocardial infarction (STEMI). Seventy-five STEMI patients who had received emergency reperfusion therapy were enrolled and randomized into the hydrophilic statin group (rosuvastatin; 5 mg/day, n = 38) and hydrophobic statin group (atorvastatin; 10 mg/day, n = 37) for 6 months. LV ejection fraction (LVEF), and B-type natriuretic peptide (BNP) and co-enzyme Q10 (CoQ10) levels were measured at baseline and the end of treatment. The myocardial salvage index was assessed by single photon emission computed tomography with (123-)I-β-methyl-iodophenylpentadecanoic acid (ischemic area-at-risk at onset of STEMI: AAR) and (201-)thallium scintigraphy (area-at-infarction at 6 months: AAI) [myocardial salvage index = (AAR-AAI) × 100/AAR (%)]. Onset-to-balloon time and maximum creatine phosphokinase levels were comparable between the groups. After 6 months, rosuvastatin (-37.6% ± 17.2%) and atorvastatin (-32.4% ± 22.4%) equally reduced low-density lipoprotein-cholesterol (LDL-C) levels (p = 0.28). However, rosuvastatin (+3.1% ± 5.9%, p < 0.05), but not atorvastatin (+1.6% ± 5.7%, p = 0.15), improved LVEF. Rosuvastatin reduced BNP levels compared with atorvastatin (-53.3% ± 48.8% versus -13.8% ± 82.9%, p < 0.05). The myocardial salvage index was significantly higher in the rosuvastatin group than the atorvastatin group (78.6% ± 29.1% versus 52.5% ± 38.0%, p < 0.05). CoQ10/LDL-C levels at 6 months were increased in the rosuvastatin group (+23.5%, p < 0.01) and percent changes in CoQ10/LDL-C were correlated with the myocardial salvage index (r = 0.56, p < 0.01). Rosuvastatin shows better beneficial effects on myocardial salvage than atorvastatin in STEMI patients, including long-term cardiac function, associated with

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

    NARCIS (Netherlands)

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

    2012-01-01

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

  13. Quantitative troponin and death, cardiogenic shock, cardiac arrest and new heart failure in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS): insights from the Global Registry of Acute Coronary Events.

    Science.gov (United States)

    Jolly, Sanjit S; Shenkman, Heather; Brieger, David; Fox, Keith A; Yan, Andrew T; Eagle, Kim A; Steg, P Gabriel; Lim, Ki-Dong; Quill, Ann; Goodman, Shaun G

    2011-02-01

    The objective of this study was to determine if the extent of quantitative troponin elevation predicted mortality as well as in-hospital complications of cardiac arrest, new heart failure and cardiogenic shock. 16,318 patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) from the Global Registry of Acute Coronary Events (GRACE) were included. The maximum 24 h troponin value as a multiple of the local laboratory upper limit of normal was used. The population was divided into five groups based on the degree of troponin elevation, and outcomes were compared. An adjusted analysis was performed using quantitative troponin as a continuous variable with adjustment for known prognostic variables. For each approximate 10-fold increase in the troponin ratio, there was an associated increase in cardiac arrest, sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) (1.0, 2.4, 3.4, 5.9 and 13.4%; p<0.001 for linear trend), cardiogenic shock (0.5, 1.4, 2.0, 4.4 and 12.7%; p<0.001), new heart failure (2.5, 5.1, 7.4, 11.6 and 15.8%; p<0.001) and mortality (0.8, 2.2, 3.0, 5.3 and 14.0%; p<0.001). These findings were replicated using the troponin ratio as a continuous variable and adjusting for covariates (cardiac arrest, sustained VT or VF, OR 1.56, 95% CI 1.39 to 1.74; cardiogenic shock, OR 1.87, 95% CI 1.61 to 2.18; and new heart failure, OR 1.57, 95% CI 1.45 to 1.71). The degree of troponin elevation was predictive of early mortality (HR 1.61, 95% CI 1.44 to 1.81; p<0.001 for days 0-14) and longer term mortality (HR 1.18, 95% CI 1.07 to 1.30, p=0.001 for days 15-180). The extent of troponin elevation is an independent predictor of morbidity and mortality.

  14. Early invasive versus non-invasive treatment in patients with non-ST-elevation acute coronary syndrome (FRISC-II): 15 year follow-up of a prospective, randomised, multicentre study.

    Science.gov (United States)

    Wallentin, Lars; Lindhagen, Lars; Ärnström, Elisabet; Husted, Steen; Janzon, Magnus; Johnsen, Søren Paaske; Kontny, Frederic; Kempf, Tibor; Levin, Lars-Åke; Lindahl, Bertil; Stridsberg, Mats; Ståhle, Elisabeth; Venge, Per; Wollert, Kai C; Swahn, Eva; Lagerqvist, Bo

    2016-10-15

    The FRISC-II trial was the first randomised trial to show a reduction in death or myocardial infarction with an early invasive versus a non-invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome. Here we provide a remaining lifetime perspective on the effects on all cardiovascular events during 15 years' follow-up. The FRISC-II prospective, randomised, multicentre trial was done at 58 Scandinavian centres in Sweden, Denmark, and Norway. Between June 17, 1996, and Aug 28, 1998, we randomly assigned (1:1) 2457 patients with non-ST-elevation acute coronary syndrome to an early invasive treatment strategy, aiming for revascularisation within 7 days, or a non-invasive strategy, with invasive procedures at recurrent symptoms or severe exercise-induced ischaemia. Plasma for biomarker analyses was obtained at randomisation. For long-term outcomes, we linked data with national health-care registers. The primary endpoint was a composite of death or myocardial infarction. Outcomes were compared as the average postponement of the next event, including recurrent events, calculated as the area between mean cumulative count-of-events curves. Analyses were done by intention to treat. At a minimum of 15 years' follow-up on Dec 31, 2014, data for survival status and death were available for 2421 (99%) of the initially recruited 2457 patients, and for other events after 2 years for 2182 (89%) patients. During follow-up, the invasive strategy postponed death or next myocardial infarction by a mean of 549 days (95% CI 204-888; p=0·0020) compared with the non-invasive strategy. This effect was larger in non-smokers (mean gain 809 days, 95% CI 402-1175; p interaction =0·0182), patients with elevated troponin T (778 days, 357-1165; p interaction =0·0241), and patients with high concentrations of growth differentiation factor-15 (1356 days, 507-1650; p interaction =0·0210). The difference was mainly driven by postponement of new myocardial infarction

  15. Right bundle branch block and anterior wall ST elevation myocardial infarction.

    Science.gov (United States)

    Trofin, Monica; Israel, Carsten W; Barold, S Serge

    2017-09-01

    We report the case of an acute anterior wall ST elevation myocardial infarction with new left anterior fascicular block and pre-existing right bundle branch block. Due to a wide right bundle branch block, no ST segment elevation was visible in lead V1. The left anterior fascicular block was caused by proximal occlusion of the left artery descending and disappeared after acute revascularization. However, also the R' of the right bundle branch block became significantly shorter after revascularization, dismanteling a minor ST segment elevation. The ST elevation in lead V1 in anterior wall infarction and right bundle branch block may merge with the R' and cause a further QRS widening as an "equivalent" to the ST elevation.

  16. Using a Cloud Computing System to Reduce Door-to-Balloon Time in Acute ST-Elevation Myocardial Infarction Patients Transferred for Percutaneous Coronary Intervention.

    Science.gov (United States)

    Ho, Chi-Kung; Chen, Fu-Cheng; Chen, Yung-Lung; Wang, Hui-Ting; Lee, Chien-Ho; Chung, Wen-Jung; Lin, Cheng-Jui; Hsueh, Shu-Kai; Hung, Shin-Chiang; Wu, Kuan-Han; Liu, Chu-Feng; Kung, Chia-Te; Cheng, Cheng-I

    2017-01-01

    This study evaluated the impact on clinical outcomes using a cloud computing system to reduce percutaneous coronary intervention hospital door-to-balloon (DTB) time for ST segment elevation myocardial infarction (STEMI). A total of 369 patients before and after implementation of the transfer protocol were enrolled. Of these patients, 262 were transferred through protocol while the other 107 patients were transferred through the traditional referral process. There were no significant differences in DTB time, pain to door of STEMI receiving center arrival time, and pain to balloon time between the two groups. Pain to electrocardiography time in patients with Killip I/II and catheterization laboratory to balloon time in patients with Killip III/IV were significantly reduced in transferred through protocol group compared to in traditional referral process group (both p cloud computing system in our present protocol did not reduce DTB time.

  17. Pooled Analysis Comparing the Efficacy of Intracoronary Versus Intravenous Abciximab in Smokers Versus Nonsmokers Undergoing Primary Percutaneous Coronary Revascularization for Acute ST-Elevation Myocardial Infarction

    DEFF Research Database (Denmark)

    Piccolo, Raffaele; Galasso, Gennaro; Eitel, Ingo

    2016-01-01

    Cigarette smokers with ST-segment elevation myocardial infarction (STEMI) may present different response to potent antithrombotic therapy compared to nonsmokers. We assessed the impact of smoking status and intracoronary abciximab in patients with STEMI undergoing primary percutaneous coronary...... intervention (PCI). We pooled data from 5 randomized trials comparing intracoronary versus intravenous abciximab bolus in patients undergoing primary PCI. The primary end point was the composite of death or reinfarction at a mean follow-up of 292 ± 138 days. Of 3,158 participants, 1,369 (43.3%) were smokers......, and they had a lower risk of the primary end point in crude, but not in adjusted analyses (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.63 to 1.21, p = 0.405). Intracoronary versus intravenous abciximab was associated with a significant reduction in the risk of primary end point among smokers (3...

  18. The prognostic significance of early and late right precordial lead (V4 R) ST-segment elevation in patients with acute anterior myocardial infarction.

    Science.gov (United States)

    Keskin, Muhammed; Uzun, Ahmet Okan; Börklü, Edibe Betül; Hayıroğlu, Mert İlker; Türkkan, Ceyhan; Tekkeşin, Ahmet İlker; Kozan, Ömer

    2018-03-01

    The predictive significance of ST-segment elevation (STE) in lead V 4 R in patients with anterior ST-segment elevation myocardial infarction (STEMI) has not been well-understood. In this study, we evaluated the prognostic value of early and late STE in lead V 4 R in patients with anterior STEMI. A total 451 patients with anterior STEMI who treated with primary percutaneous coronary intervention (PPCI) were prospectively enrolled in this study. All patients were classified according to presence of STE (>1 mm) in lead V 4 R at admission and/or 60 min after PPCI. Based on this classification, all patients were divided into three subgroups as no V 4 R STE (Group 1), early but not late V 4 R STE (Group 2) and late V 4 R STE (Group 3). In-hospital mortality had higher rates at group 2 and 3 and that had 2.1 and 4.1-times higher mortality than group 1. Late V 4 R STE remained as an independent risk factor for cardiogenic shock (odds ratio [OR] 2.6; 95% confidence interval [CI] 1.9-4.3; p < .001) and in-hospital mortality (OR 2.3; 95% CI 1.8-4.1; p < .001). The 12-month overall survival for group 1, 2, and 3 were 91.1%, 82.4%, and 71.4% respectively. However, the long-term mortality also had the higher rate at group 3; late V 4 R STE did not remain as an independent risk factor for long-term mortality (OR 1.5; 95% CI 0.8-4.1; p: .159). Late V 4 R STE in patients with anterior STEMI is strongly associated with poor prognosis. The record of late V 4 R in patients with anterior STEMI has an important prognostic value. © 2017 Wiley Periodicals, Inc.

  19. Comparison of the efficacy of pharmacoinvasive management for ST-segment elevation myocardial infarction in smokers versus non-smokers (from the Trial of Routine Angioplasty and Stenting After Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction).

    Science.gov (United States)

    Tan, Nigel S; Goodman, Shaun G; Cantor, Warren J; Tan, Mary K; Yan, Raymond T; Bagnall, Alan J; Mehta, Shamir R; Fitchett, David; Strauss, Bradley H; Yan, Andrew T

    2014-10-01

    Compared with non-smokers, cigarette smokers with ST-segment elevation myocardial infarctions derive greater benefit from fibrinolytic therapy. However, it is not known whether the optimal treatment strategy after fibrinolysis differs on the basis of smoking status. The Trial of Routine Angioplasty and Stenting After Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction (TRANSFER-AMI) randomized patients with ST-segment elevation myocardial infarctions to a routine early invasive (pharmacoinvasive) versus a standard (early transfer only for rescue percutaneous coronary intervention or delayed angiography) strategy after fibrinolysis. The efficacy of these strategies was compared in 1,051 patients on the basis of their smoking status. Treatment heterogeneity was assessed between smokers and non-smokers, and multivariable analysis was performed to evaluate for an interaction between smoking status and treatment strategy after adjusting for baseline Global Registry of Acute Coronary Events (GRACE) risk score. Smokers (n=448) were younger, had fewer cardiovascular risk factors, and had lower GRACE risk scores. They had a lower rate of the primary composite end point of 30-day mortality, reinfarction, recurrent ischemia, heart failure, or cardiogenic shock and fewer deaths or reinfarctions at 6 months and 1 year. Smoking status was not a significant predictor of either primary or secondary end points in multivariable analysis. Pharmacoinvasive management reduced the primary end point compared with standard therapy in smokers (7.7% vs 13.6%, p=0.04) and non-smokers (13.1% vs 19.7%, p=0.03). Smoking status did not modify treatment effect on any measured outcomes (p>0.10 for all). In conclusion, compared with non-smokers, current smokers receiving either standard or early invasive management of ST-segment elevation myocardial infarction after fibrinolysis have more favorable outcomes, which is likely attributable to their better baseline risk profile. The

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

    Science.gov (United States)

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

    2015-12-15

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

  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...

  2. 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.

  3. 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

    International Nuclear Information System (INIS)

    Pereira-da-Silva, Tiago; Bernardes, Luís; Cacela, Duarte; Fiarresga, António; Sousa, Lídia; Patrício, Lino; Ferreira, Rui Cruz

    2013-01-01

    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

  4. 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

    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. To estimate utilization, knowledge, and perceptions of EMS among patients with ST-elevation myocardial infarction (STEMI) in the Emirate of Abu Dhabi. 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. 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. 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.

  5. 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

  6. Using a Cloud Computing System to Reduce Door-to-Balloon Time in Acute ST-Elevation Myocardial Infarction Patients Transferred for Percutaneous Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Chi-Kung Ho

    2017-01-01

    Full Text Available Background. This study evaluated the impact on clinical outcomes using a cloud computing system to reduce percutaneous coronary intervention hospital door-to-balloon (DTB time for ST segment elevation myocardial infarction (STEMI. Methods. A total of 369 patients before and after implementation of the transfer protocol were enrolled. Of these patients, 262 were transferred through protocol while the other 107 patients were transferred through the traditional referral process. Results. There were no significant differences in DTB time, pain to door of STEMI receiving center arrival time, and pain to balloon time between the two groups. Pain to electrocardiography time in patients with Killip I/II and catheterization laboratory to balloon time in patients with Killip III/IV were significantly reduced in transferred through protocol group compared to in traditional referral process group (both p<0.05. There were also no remarkable differences in the complication rate and 30-day mortality between two groups. The multivariate analysis revealed that the independent predictors of 30-day mortality were elderly patients, advanced Killip score, and higher level of troponin-I. Conclusions. This study showed that patients transferred through our present protocol could reduce pain to electrocardiography and catheterization laboratory to balloon time in Killip I/II and III/IV patients separately. However, this study showed that using a cloud computing system in our present protocol did not reduce DTB time.

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

    Directory of Open Access Journals (Sweden)

    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.

  8. Prognostic value of mid-regional pro-adrenomedullin levels taken on admission and discharge in non-ST-elevation myocardial infarction: the LAMP (Leicester Acute Myocardial Infarction Peptide) II study.

    Science.gov (United States)

    Dhillon, Onkar S; Khan, Sohail Q; Narayan, Hafid K; Ng, Kelvin H; Struck, Joachim; Quinn, Paulene A; Morgenthaler, Nils G; Squire, Iain B; Davies, Joan E; Bergmann, Andreas; Ng, Leong L

    2010-07-06

    The purpose of this study was to assess the prognostic value of admission and discharge mid-regional pro-adrenomedullin (sAM) levels in non-ST-elevation myocardial infarction (MI) and identify values to aid clinical decision making. N-terminal pro-B-type natriuretic peptide and GRACE (Global Registry of Acute Coronary Events) score were used as comparators. sAM is a stable precursor of adrenomedullin. We measured plasma sAM on admission and discharge in 745 non-ST-elevation MI patients (514 men, median age 70.0 +/- 12.7 years). The primary end point was a composite of death, heart failure, hospitalization, and recurrent acute MI over mean follow-up of 760 days (range 150 to 2,837 days), with each event assessed individually as secondary end points. During follow-up, 120 (16.1%) patients died, and there were 65 (8.7%) hospitalizations for heart failure and 77 (10.3%) recurrent acute MIs. Both admission and discharge levels were increased (median 0.81 nmol/l [range 0.06 to 5.75 nmol/l] and 0.76 nmol/l [range 0.25 to 6.95 nmol/l], respectively) compared with established normal ranges. Multivariate adjusted Cox regression models revealed that both were associated with the primary end point (hazard ratio: 9.75 on admission and 7.54 on discharge; both p 1.11 nmol/l identified those at highest risk of death (p 1.11 nmol/l, complements the GRACE score to improve risk stratification. Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  9. ASSOCIATION OF A LYMPHOTOXIN-α VARIABLE SITE rs1041981 WITH DEVELOPMENT OF LONG-TERM UNFAVORABLE OUTCOMES IN PATIENTS WITH ACUTE CORONARY SYNDROME WITHOUT ST-SEGMENT ELEVATION

    Directory of Open Access Journals (Sweden)

    E. A. Shmidt

    2018-01-01

    Full Text Available Lymphotoxin-α (LTA is a major pro-inflammatory cytokine produced at the early stages of vascular inflammation, taking part in the formation of arterial atherosclerosis and development of coronary heart disease. Functional changes in the gene encoding LTA production may influence the development of coronary heart disease with unfavorable progression. However, studies for associations between rs1041981 (C-804A LTA gene variant and development of acute cerebrovascular accidents, myocardial infarction, and severity of coronary atherosclerosis have yielded contradictory results. The purpose of our study was to investigate an association of rs1041981 gene LTA with risk of adverse events within five years of follow-up in the patients with acute coronary syndrome without ST elevation ST (nonST-ACS. 178 patients with nonST-ACS from the Kemerovo Cardiology Center Registry were included into the study. Genotyping of rs1041981 site variable LTA gene was performed by TaqMan technique using an “iCycler iQ” device (BIO-RAD, USA. Results: we have found that the A allele and A/A genotype polymorphism in LTA gene (rs1041981 have been associated with development of adverse cardiovascular events over five years of observation (respective p levels were 0.02 and 0.036. In patients with A/A genotype, the rs1041981 polymorphism in LTA gene was associated with 3.8-fold increase in adverse cardiovascular events, compared to patients having A/C or C/C genotype. Carriage of A allele in LTA gene (rs1041981 doubles the risk of adverse cardiovascular events in patients with nonST-ACS at long observation terms. By means of Kaplan-Meier method, we have determined that survival to the first endpoint occurred more often in carriers of the genotype A/A of LTA gene (rs1041981. The A/A genotype of LTA gene (rs1041981 proved to be more significant (p = 0.016 for development of adverse outcomes, when combining the patients with A/C and C/C genotypes. One may draw a conclusion

  10. Effect of intravenous TRO40303 as an adjunct to primary percutaneous coronary intervention for acute ST-elevation myocardial infarction: MITOCARE study results.

    Science.gov (United States)

    Atar, Dan; Arheden, Håkan; Berdeaux, Alain; Bonnet, Jean-Louis; Carlsson, Marcus; Clemmensen, Peter; Cuvier, Valérie; Danchin, Nicolas; Dubois-Randé, Jean-Luc; Engblom, Henrik; Erlinge, David; Firat, Hüseyin; Halvorsen, Sigrun; Hansen, Henrik Steen; Hauke, Wilfried; Heiberg, Einar; Koul, Sasha; Larsen, Alf-Inge; Le Corvoisier, Philippe; Nordrehaug, Jan Erik; Paganelli, Franck; Pruss, Rebecca M; Rousseau, Hélène; Schaller, Sophie; Sonou, Giles; Tuseth, Vegard; Veys, Julien; Vicaut, Eric; Jensen, Svend Eggert

    2015-01-07

    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). Patients presenting with STEMI within 6 h of the onset of pain randomly received TRO40303 (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. Secondary endpoints included measures of infarct size using cardiac magnetic resonance (CMR) and safety outcomes. The median pain-to-balloon time was 180 min for both groups, and the median (mean) door-to-balloon time was 60 (38) min for all sites. Infarct size, as measured by CK and TnI AUCs at 3 days, was not significantly different between treatment groups. There were no significant differences in the CMR-assessed myocardial salvage index (1-infarct size/myocardium at risk) (mean 52 vs. 58% with placebo, P = 0.1000), mean CMR-assessed infarct size (21.9 g vs. 20.0 g, or 17 vs. 15% of LV-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. This study in STEMI patients treated with contemporary mechanical revascularization principles did not show any effect of TRO40303 in limiting reperfusion injury of the ischaemic myocardium. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

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

    Science.gov (United States)

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

    2016-12-01

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

  12. Comparison of Safety and Effectiveness Between Right Versus Left Radial Arterial Access in Primary Percutaneous Coronary Intervention for Acute ST Segment Elevation Myocardial Infarction.

    Science.gov (United States)

    Elmahdy, Mahmoud Farouk; ElMaghawry, Mohamed; Hassan, Mohamed; Kassem, Hussien Heshmat; Said, Karim; Elfaramawy, Amr AbdelAziz

    2017-01-01

    Transradial approach (TRA) is now considered the standard of care in many centres for elective and primary percutaneous intervention (PCI). The use of the radial approach in ST segment elevation myocardial infarction (STEMI) patients has been associated with a significant reduction in major adverse cardiac events. However, it is still unclear if the side of radial access (right vs. left) has impact on safety and effectiveness of TRA in primary PCI. So this study was conducted to compare the safety, feasibility, and outcomes of right radial access (RRA) vs. left radial access (LRA) in the setting of primary PCI. We retrospectively analysed the data of 400 consecutive patients presenting to our institution with STEMI for whom primary PCIs were performed via RRA and LRA. Mean age of the whole studied population was 57±12.8 years, with male predominance (77.2%). There were 202 cases in the RRA group and 198 in the LRA group, with no significant difference in demographics and clinical characteristics for patients included in both groups. There was no significant difference in procedure success rate (97.5% for RRA vs. 98.4% for LRA; P=0.77). In addition, no significant difference between both approaches was observed in the contrast volume, number of catheters, fluoroscopy time (FT), needle-to-balloon time, post-procedure vascular complications, in hospital reinfarction, stroke/transient ischaemic attack (TIA) or death. Right radial access and LRA are equally safe and effective in the setting of primary PCI. Both approaches have a high success rate and comparable needle-to-balloon time. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  13. Impact on Mortality of Different Network Systems in the Treatment of ST-segment Elevation Acute Myocardial Infarction. The Spanish Experience.

    Science.gov (United States)

    Cequier, Ángel; Ariza-Solé, Albert; Elola, Francisco J; Fernández-Pérez, Cristina; Bernal, José L; Segura, José V; Iñiguez, Andrés; Bertomeu, Vicente

    2017-03-01

    To analyze the association between the development of network systems of care for ST-segment elevation myocardial infarction (STEMI) in the autonomous communities (AC) of Spain and the regional rate of percutaneous coronary intervention (PCI) and in-hospital mortality. From 2003 to 2012, data from the minimum basic data set of the Spanish taxpayer-funded health system were analyzed, including admissions from general hospitals. Diagnoses of STEMI and related procedures were codified by the International Diseases Classification. Discharge episodes (n = 302 471) were distributed in 3 groups: PCI (n = 116 621), thrombolysis (n = 46 720), or no reperfusion (n = 139 130). Crude mortality throughout the evaluation period was higher for the no-PCI or thrombolysis group (17.3%) than for PCI (4.8%) and thrombolysis (8.6%) (P < .001). For the aggregate of all communities, the PCI rate increased (21.6% in 2003 vs 54.5% in 2012; P < .001) with a decrease in risk-standardized mortality rates (10.2% in 2003; 6.8% in 2012; P < .001). Significant differences were observed in the PCI rate across the AC. The development of network systems was associated with a 50% increase in the PCI rate (P < .001) and a 14% decrease in risk-standardized mortality rates (P < .001). From 2003 to 2012, the PCI rate in STEMI substantially increased in Spain. The development of network systems was associated with an increase in the PCI rate and a decrease in in-hospital mortality. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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.

  15. 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.

  16. Role of myocardial ischemia on exercise-induced ST elevation

    International Nuclear Information System (INIS)

    Saito, Muneyasu; Sumiyoshi, Tetsuya; Nishimura, Tsunehiko; Uehara, Toshiisa; Hayashida, Kouhei; Haze, Kazuo; Fukami, Ken-ichi; Hiramori, Katsuhiko

    1986-01-01

    Exercise-induced ST elevation in patients with previous myocardial infarction (MI) has been recognized to be related to left ventricular (LV) asynergy, however it is also recognized that myocardial ischemia can induce ST elevation. In this study, factors which determine the extent of ST elevation, with special reference to myocardial ischemia, was re-evaluated using quantitative analysis of stress myocardial scintigraphy (S-SG). Among 65 patients with previous anterior myocardial infarction and documented single vessel disease of left anterior descending artery (LAD), 19 patients who had exercise-induced ST elevationST ≥ 2.0 mm) had more abnormal Q waves (p < 0.01), lower LV ejection fraction (EF) (p < 0.01), more severe LV asynergy (p < 0.05) and less incidence of post-MI angina pectoris (AP) (p < 0.01), compared to those with ΔST < 2.0 mm, indicating that ST elevation is primarily related to LV asynergy. Correlation studies among clinical, angiographic and scintigraphic parameters show that ΔST was significantly related to a size of MI represented by Tl score or relative defect Tl activity and number of abnormal Q waves (No.Q), the magnitude of work load expressed by changes in double product (ΔDP) and intervals between the onset and exercise test, as well as myocardial ischemia expressed by the extent of redistribution (%RD) in S-SG. Among 23 patients with post-MI AP, ΔST significantly correlated with %RD (r = 0.47), indicating that myocardial ischemia can be a mechanism of exercise-induced ST elevation in patients with previous MI. Furtheremore, among those with ST elevation, concave-type ST elevation was more related to myocardial ischemia compared to convex-type ST elevation as expressed by the incidence of post-MI AP and/or significant redistribution. (J.P.N.)

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

    Science.gov (United States)

    Zhang, Qi; Qiu, Jian-Ping; Zhang, Rui-Yan; Li, Yi-Gang; He, Ben; Jin, Hui-Gen; Zhang, Jun-Feng; Wang, Xiao-Long; Jiang, Li; Liao, Min-Lei; Hu, Jian; Shen, Wei-Feng

    2010-04-05

    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. 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. 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 procedural features, there were no significant difference in either in-hospital (OR = 0.77, 95%CI of 0.48 to 1.22, P = 0.30) or 30-day mortality (OR = 1.28, 95%CI of 0.73 to 2.23, P = 0.38) between women and men. 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.

  18. Early Ventricular Tachycardia or Fibrillation in Patients With ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention and Impact on Mortality and Stent Thrombosis (from the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction Trial).

    Science.gov (United States)

    Kosmidou, Ioanna; Embacher, Monica; McAndrew, Thomas; Dizon, José M; Mehran, Roxana; Ben-Yehuda, Ori; Mintz, Gary S; Stone, Gregg W

    2017-11-15

    The prevalence and impact of early ventricular arrhythmias (ventricular tachycardia [VT]/ventricular fibrillation [VF]) occurring before mechanical revascularization for acute ST segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention are poorly understood. We sought to investigate the association between early VT/VF and long-term clinical outcomes using data from the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction trial. Among 3,602 patients with STEMI, 108 patients (3.0%) had early VT/VF. Baseline clinical characteristics were similar in patients with versus without early VT/VF. Patients with early VT/VF had shorter symptom-to-balloon times and lower left ventricular ejection fraction and underwent more frequent thrombectomy compared with patients without early VT/VF. Adjusted 3-year rates of all-cause death (15.7% vs 6.5%; adjusted hazard ratio 2.62, 95% confidence interval 1.48 to 4.61, p stent thrombosis (13.7% vs 5.7%; adjusted hazard ratio 2.74, 95% confidence interval 1.52 to 4.93, p Stents in Acute Myocardial Infarction trial, VT/VF occurring before coronary angiography and revascularization in patients with STEMI was strongly associated with increased 3-year rates of death and stent thrombosis. Further investigation into the mechanisms underlying the increased risk of early stent thrombosis in patients with early VT/VF is required. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Remote Ischemic Postconditioning (RIPC) of the Upper Arm Results in Protection from Cardiac Ischemia-Reperfusion Injury Following Primary Percutaneous Coronary Intervention (PCI) for Acute ST-Segment Elevation Myocardial Infarction (STEMI).

    Science.gov (United States)

    Cao, Bangming; Wang, Haipeng; Zhang, Chi; Xia, Ming; Yang, Xiangjun

    2018-02-19

    BACKGROUND The aim of this study was to evaluate the role of remote ischemic postconditioning (RIPC) of the upper arm on protection from cardiac ischemia-reperfusion injury following primary percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). MATERIAL AND METHODS Eighty patients with STEMI were randomized into two groups: primary PCI (N=44) and primary PCI+RIPC (N=36). RIPC consisted of four cycles of 5 minutes of occlusion and five minutes of reperfusion by cuff inflation and deflation of the upper arm, commencing within one minute of the first PCI balloon dilatation. Peripheral venous blood samples were collected before PCI and at 0.5, 8, 24, 48, and 72 hours after PCI. Levels of creatine kinase-MB (CK-MB), serum creatinine (Cr), nitric oxide (NO), and stromal cell-derived factor-1α (SDF-1α) were measured. The rates of acute kidney injury (AKI) and the estimated glomerular filtration rate (eGFR) were calculated. RESULTS Patients in the primary PCI+RIPC group, compared with the primary PCI group, had significantly lower peak CK-MB concentrations (PPCI in patients with acute STEMI might provide cardiac and renal protection from ischemia-reperfusion injury via the actions of SDF-1α, and NO.

  20. Electrocardiographic scores of severity and acuteness of myocardial ischemia predict myocardial salvage in patients with anterior ST-segment elevation myocardial infarction

    DEFF Research Database (Denmark)

    Fakhri, Yama; Sejersten, Maria; Schoos, Mikkel Malby

    2018-01-01

    inferior infarct locations. METHODS: In STEMI patients, the severity and acuteness scores were obtained from the admission ECG. Based on the ECG patients were assigned with severe or non-severe ischemia and acute or non-acute ischemia. Cardiac magnetic resonance (CMR) was performed 2-6days after primary...

  1. Quantification of both the area-at-risk and acute myocardial infarct size in ST-segment elevation myocardial infarction using T1-mapping.

    Science.gov (United States)

    Bulluck, Heerajnarain; Hammond-Haley, Matthew; Fontana, Marianna; Knight, Daniel S; Sirker, Alex; Herrey, Anna S; Manisty, Charlotte; Kellman, Peter; Moon, James C; Hausenloy, Derek J

    2017-08-01

    A comprehensive cardiovascular magnetic resonance (CMR) in reperfused ST-segment myocardial infarction (STEMI) patients can be challenging to perform and can be time-consuming. We aimed to investigate whether native T1-mapping can accurately delineate the edema-based area-at-risk (AAR) and post-contrast T1-mapping and synthetic late gadolinium (LGE) images can quantify MI size at 1.5 T. Conventional LGE imaging and T2-mapping could then be omitted, thereby shortening the scan duration. Twenty-eight STEMI patients underwent a CMR scan at 1.5 T, 3 ± 1 days following primary percutaneous coronary intervention. The AAR was quantified using both native T1 and T2-mapping. MI size was quantified using conventional LGE, post-contrast T1-mapping and synthetic magnitude-reconstructed inversion recovery (MagIR) LGE and synthetic phase-sensitive inversion recovery (PSIR) LGE, derived from the post-contrast T1 maps. Native T1-mapping performed as well as T2-mapping in delineating the AAR (41.6 ± 11.9% of the left ventricle [% LV] versus 41.7 ± 12.2% LV, P = 0.72; R 2 0.97; ICC 0.986 (0.969-0.993); bias -0.1 ± 4.2% LV). There were excellent correlation and inter-method agreement with no bias, between MI size by conventional LGE, synthetic MagIR LGE (bias 0.2 ± 2.2%LV, P = 0.35), synthetic PSIR LGE (bias 0.4 ± 2.2% LV, P = 0.060) and post-contrast T1-mapping (bias 0.3 ± 1.8% LV, P = 0.10). The mean scan duration was 58 ± 4 min. Not performing T2 mapping (6 ± 1 min) and conventional LGE (10 ± 1 min) would shorten the CMR study by 15-20 min. T1-mapping can accurately quantify both the edema-based AAR (using native T1 maps) and acute MI size (using post-contrast T1 maps) in STEMI patients without major cardiovascular risk factors. This approach would shorten the duration of a comprehensive CMR study without significantly compromising on data acquisition and would obviate the need to perform T2 maps and LGE imaging.

  2. Indoleamine 2,3-Dioxygenase (IDO) Enzyme Links Innate Immunity and Altered T-Cell Differentiation in Non-ST Segment Elevation Acute Coronary Syndrome.

    Science.gov (United States)

    Zara, Chiara; Severino, Anna; Flego, Davide; Ruggio, Aureliano; Pedicino, Daniela; Giglio, Ada Francesca; Trotta, Francesco; Lucci, Claudia; D'Amario, Domenico; Vinci, Ramona; Pisano, Eugenia; La Rosa, Giulio; Biasucci, Luigi Marzio; Crea, Filippo; Liuzzo, Giovanna

    2017-12-26

    Atherosclerosis is a chronic inflammatory disease characterized by a complex interplay between innate and adaptive immunity. Dendritic cells (DCs) play a key role in T-cell activation and regulation by promoting a tolerogenic environment through the expression of the immunosuppressive enzyme indoleamine 2,3-dioxygenase (IDO), an intracellular enzyme involved in tryptophan catabolism. IDO expression and activity was analyzed in monocytes derived DCs (MDDCs) from non-ST segment elevation myocardial infarction (NSTEMI) patients, stable angina (SA) patients and healthy controls (HC) by real-time quantitative polymerase chain reaction (RT-qPCR) before and after in vitro maturation with lipopolysaccharide (LPS). The amount of tryptophan catabolite; kynurenine; was evaluated in the culture supernatants of mature-MDDCs by ELISA assay. Autologous mixed lymphocyte reaction (MLR) between mature-MDDCs and naïve T-cells was carried out to study the differentiation towards T-helper 1 (Th1) and induced regulatory T-cells (iTreg). Analysis of IDO mRNA transcripts in mature-MDDCs revealed a significant reduction in cells isolated from NSTEMI (625.0 ± 128.2; mean ± SEM) as compared with those from SA (958.5 ± 218.3; p = 0.041) and from HC (1183.6 ± 231.6; p = 0.034). Furthermore; the concentration of kynurenine was lower in NSTEMI patients (2.78 ± 0.2) and SA (2.98 ± 0.25) as compared with HC (5.1 ± 0.69 ng/mL; p = 0.002 and p = 0.016; respectively). When IDO-competent mature-MDDCs were co-cultured with allogeneic naïve T-cells, the ratio between the percentage of generated Th1 and iTreg was higher in NSTEMI (4.4 ± 2.9) than in SA (1.8 ± 0.6; p = 0.056) and HC (0.9 ± 0.3; p = 0.008). In NSTEMI, the tolerogenic mechanism of the immune response related to IDO production by activated MDDCs is altered, supporting their role in T-cell dysregulation.

  3. Indoleamine 2,3-Dioxygenase (IDO Enzyme Links Innate Immunity and Altered T-Cell Differentiation in Non-ST Segment Elevation Acute Coronary Syndrome

    Directory of Open Access Journals (Sweden)

    Chiara Zara

    2017-12-01

    Full Text Available Atherosclerosis is a chronic inflammatory disease characterized by a complex interplay between innate and adaptive immunity. Dendritic cells (DCs play a key role in T-cell activation and regulation by promoting a tolerogenic environment through the expression of the immunosuppressive enzyme indoleamine 2,3-dioxygenase (IDO, an intracellular enzyme involved in tryptophan catabolism. IDO expression and activity was analyzed in monocytes derived DCs (MDDCs from non-ST segment elevation myocardial infarction (NSTEMI patients, stable angina (SA patients and healthy controls (HC by real-time quantitative polymerase chain reaction (RT-qPCR before and after in vitro maturation with lipopolysaccharide (LPS. The amount of tryptophan catabolite; kynurenine; was evaluated in the culture supernatants of mature-MDDCs by ELISA assay. Autologous mixed lymphocyte reaction (MLR between mature-MDDCs and naïve T-cells was carried out to study the differentiation towards T-helper 1 (Th1 and induced regulatory T-cells (iTreg. Analysis of IDO mRNA transcripts in mature-MDDCs revealed a significant reduction in cells isolated from NSTEMI (625.0 ± 128.2; mean ± SEM as compared with those from SA (958.5 ± 218.3; p = 0.041 and from HC (1183.6 ± 231.6; p = 0.034. Furthermore; the concentration of kynurenine was lower in NSTEMI patients (2.78 ± 0.2 and SA (2.98 ± 0.25 as compared with HC (5.1 ± 0.69 ng/mL; p = 0.002 and p = 0.016; respectively. When IDO-competent mature-MDDCs were co-cultured with allogeneic naïve T-cells, the ratio between the percentage of generated Th1 and iTreg was higher in NSTEMI (4.4 ± 2.9 than in SA (1.8 ± 0.6; p = 0.056 and HC (0.9 ± 0.3; p = 0.008. In NSTEMI, the tolerogenic mechanism of the immune response related to IDO production by activated MDDCs is altered, supporting their role in T-cell dysregulation.

  4. 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...

  5. Lyme Carditis Buried Beneath ST-Segment Elevations

    Directory of Open Access Journals (Sweden)

    Basia Michalski

    2017-01-01

    Full Text Available Lyme disease is caused by the spirochete Borrelia burgdorferi and is carried to human hosts by infected ticks. There are nearly 30,000 cases of Lyme disease reported to the CDC each year, with 3-4% of those cases reporting Lyme carditis. The most common manifestation of Lyme carditis is partial heart block following bacterial-induced inflammation of the conducting nodes. Here we report a 45-year-old gentleman that presented to the hospital with intense nonradiating chest pressure and tightness. Lab studies were remarkable for elevated troponins. EKG demonstrated normal sinus rhythm with mild ST elevations. Three weeks prior to hospital presentation, patient had gone hunting near Madison. One week prior to admission, he noticed an erythematous lesion on his right shoulder. Because of his constellation of history, arthralgias, and carditis, he was started on ceftriaxone to treat probable Lyme disease. This case illustrates the importance of thorough history taking and extensive physical examination when assessing a case of possible acute myocardial infarction. Because Lyme carditis is reversible, recognition of this syndrome in young patients, whether in the form of AV block, myocarditis, or acute myocardial ischemia, is critical to the initiation of appropriate antibiotics in order to prevent permanent heart block, or even death.

  6. Efficacy and Safety of a Pharmaco-Invasive Strategy With Half-Dose Alteplase Versus Primary Angioplasty in ST-Segment-Elevation Myocardial Infarction: EARLY-MYO Trial (Early Routine Catheterization After Alteplase Fibrinolysis Versus Primary PCI in Acute ST-Segment-Elevation Myocardial Infarction).

    Science.gov (United States)

    Pu, Jun; Ding, Song; Ge, Heng; Han, Yaling; Guo, Jinchen; Lin, Rong; Su, Xi; Zhang, Heng; Chen, Lianglong; He, Ben

    2017-10-17

    Timely primary percutaneous coronary intervention (PPCI) cannot be offered to all patients with ST-segment-elevation myocardial infarction (STEMI). Pharmaco-invasive (PhI) strategy has been proposed as a valuable alternative for eligible patients with STEMI. We conducted a randomized study to compare the efficacy and safety of a PhI strategy with half-dose fibrinolytic regimen versus PPCI in patients with STEMI. The EARLY-MYO trial (Early Routine Catheterization After Alteplase Fibrinolysis Versus Primary PCI in Acute ST-Segment-Elevation Myocardial Infarction) was an investigator-initiated, prospective, multicenter, randomized, noninferiority trial comparing a PhI strategy with half-dose alteplase versus PPCI in patients with STEMI 18 to 75 years of age presenting ≤6 hours after symptom onset but with an expected PCI-related delay. The primary end point of the study was complete epicardial and myocardial reperfusion after PCI, defined as thrombolysis in myocardial infarction flow grade 3, thrombolysis in myocardial infarction myocardial perfusion grade 3, and ST-segment resolution ≥70%. We also measured infarct size and left ventricular ejection fraction with cardiac magnetic resonance and recorded 30-day clinical and safety outcomes. A total of 344 patients from 7 centers were randomized to PhI (n=171) or PPCI (n=173). PhI was noninferior (and even superior) to PPCI for the primary end point (34.2% versus 22.8%, P noninferiority <0.05, P superiority =0.022), with no significant differences in the frequency of the individual components of the combined end point: thrombolysis in myocardial infarction flow 3 (91.3% versus 89.2%, P =0.580), thrombolysis in myocardial infarction myocardial perfusion grade 3 (65.8% versus 62.9%, P =0.730), and ST-segment resolution ≥70% (50.9% versus 45.5%, P =0.377). Infarct size (23.3%±11.3% versus 25.8%±13.7%, P =0.101) and left ventricular ejection fraction (52.2%±11.0% versus 51.4%±12.0%, P =0.562) were similar in both

  7. Effects of age on long-term outcomes after a routine invasive or selective invasive strategy in patients presenting with non-ST segment elevation acute coronary syndromes: a collaborative analysis of individual data from the FRISC II - ICTUS - RITA-3 (FIR) trials

    NARCIS (Netherlands)

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

    2012-01-01

    Objective To perform a patient-pooled analysis of a routine invasive versus a selective invasive strategy in elderly patients with non-ST segment elevation acute coronary syndrome. Methods A meta-analysis was performed of patient-pooled data from the FRISC IIeICTUSeRITA-3 (FIR) studies. (Un)adjusted

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

    NARCIS (Netherlands)

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

    2012-01-01

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

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

    DEFF Research Database (Denmark)

    Atar, Dan; Petzelbauer, Peter; Schwitter, Jürg

    2009-01-01

    by mitigating reperfusion injury. METHODS: In all, 234 patients presenting with acute ST-segment elevation myocardial infarction were randomized in 26 centers. FX06 or matching placebo was given as intravenous bolus at reperfusion. Infarct size was assessed 5 days after myocardial infarction by late gadolinium...

  10. Pneumopyopericardium mimicking an inferior ST elevation myocardial infarction with regional electrocardiogram changes: a case report.

    Science.gov (United States)

    Ratnayake, Eranda Chamara; Premaratne, Sandamali; Lokunarangoda, Niroshan; Fernando, Sanduni; Fernando, Nilanthi; Ponnamperuma, Chandrike; Santharaj, W Samuel

    2015-04-30

    Pneumopyopericardium is a rare disease with poor prognosis. The usual presentation is with fever, shortness of breath and haemodynamic compromise. The Electrocardiogram changes associated with this disease entity would be similar to pericarditis such as concave shaped ST elevations in all leads with PR sagging. Pneumopyopericardium mimicking an acute ST Elevation Myocardial Infarction, with regional Electrocardiogram changes has hitherto not been described in world literature. We describe the case of a 48 year old native Sri Lankan man, presenting with chest pain and Electrocardiogram changes compatible with an Acute ST Elevation Myocardial Infarction, subsequently found to have Pneumopyopericardium secondary to an oesophageal tear. Retrospective history revealed repetitive vomiting due to heavy alcohol consumption, prior to presentation. It unfortunately led to a fatal outcome. Pneumopyopericardium may mimic an acute ST elevation myocardial infarction with associated regional Electrocardiogram changes. A high degree of suspicion should be maintained and an adequate history should always be obtained prior to any intervention in all ST Elevation Myocardial Infarction patients.

  11. ST Elevations and Elevated Cardiac Enzymes Not Always a STEMI: Two Case Reports.

    Science.gov (United States)

    Fernández Fernández, Juan; Deliz-Guzmán, Claudia; Andino-Colón, César; Claudio-Hernández, Héctor; Lugo-Amador, Nannette

    2016-01-01

    Chest pain is a common complaint in the emergency department (ED). Besides a careful history and physical exam; electrocardiogram, laboratory tests and imaging studies are widely available diagnostic tests that are used for patient assessment. When ST elevation and elevated cardiac enzymes are present the most likely diagnosis are ST elevation myocardial infarction (STEMI) or myocarditis. In this case report we present two low risk patients for major adverse cardiac event with ST elevation and elevated cardiac enzymes and how a careful risk assessment and detailed electrocardiogram evaluation could help differentiating between these two diagnoses.

  12. ST Elevation in AVR: When Time May Not Mean Muscle

    Science.gov (United States)

    2017-10-31

    REPORT TYPE 1013112017 Presentation 4. TITLE AND SUBTITLE ST Elevation in AVR: When Thne May Not Mean !Vfu&cle 6. AUTHOR{S) Capt \\Villiam T...ACCF/AHA Guideline for the Management of ST -Elevation Myocardial Infarction A Report of the Arnerican College of C ardiology Foundation/ Ameri can...C7Q n ([) G) ro )::>t w :J r+ c.. < -· ro ti) ti) ro ti) OJ m ti) -ro n Take home points •Don’t ignore ST elevation in aVR •Look closely

  13. Revascularization Treatment of Emergency Patients with Acute ST-Segment Elevation Myocardial Infarction in Switzerland: Results from a Nationwide, Cross-Sectional Study in Switzerland for 2010-2011.

    Science.gov (United States)

    Berlin, Claudia; Jüni, Peter; Endrich, Olga; Zwahlen, Marcel

    2016-01-01

    Cardiovascular diseases are the leading cause of death worldwide and in Switzerland. When applied, treatment guidelines for patients with acute ST-segment elevation myocardial infarction (STEMI) improve the clinical outcome and should eliminate treatment differences by sex and age for patients whose clinical situations are identical. In Switzerland, the rate at which STEMI patients receive revascularization may vary by patient and hospital characteristics. To examine all hospitalizations in Switzerland from 2010-2011 to determine if patient or hospital characteristics affected the rate of revascularization (receiving either a percutaneous coronary intervention or a coronary artery bypass grafting) in acute STEMI patients. We used national data sets on hospital stays, and on hospital infrastructure and operating characteristics, for the years 2010 and 2011, to identify all emergency patients admitted with the main diagnosis of acute STEMI. We then calculated the proportion of patients who were treated with revascularization. We used multivariable multilevel Poisson regression to determine if receipt of revascularization varied by patient and hospital characteristics. Of the 9,696 cases we identified, 71.6% received revascularization. Patients were less likely to receive revascularization if they were female, and 80 years or older. In the multivariable multilevel Poisson regression analysis, there was a trend for small-volume hospitals performing fewer revascularizations but this was not statistically significant while being female (Relative Proportion = 0.91, 95% CI: 0.86 to 0.97) and being older than 80 years was still associated with less frequent revascularization. Female and older patients were less likely to receive revascularization. Further research needs to clarify whether this reflects differential application of treatment guidelines or limitations in this kind of routine data.

  14. 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.

  15. 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

  16. A user-friendly risk-score for predicting in-hospital cardiac arrest among patients admitted with suspected non ST-elevation acute coronary syndrome - The SAFER-score.

    Science.gov (United States)

    Faxén, Jonas; Hall, Marlous; Gale, Chris P; Sundström, Johan; Lindahl, Bertil; Jernberg, Tomas; Szummer, Karolina

    2017-12-01

    To develop a simple risk-score model for predicting in-hospital cardiac arrest (CA) among patients hospitalized with suspected non-ST elevation acute coronary syndrome (NSTE-ACS). Using the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART), we identified patients (n=242 303) admitted with suspected NSTE-ACS between 2008 and 2014. Logistic regression was used to assess the association between 26 candidate variables and in-hospital CA. A risk-score model was developed and validated using a temporal cohort (n=126 073) comprising patients from SWEDEHEART between 2005 and 2007 and an external cohort (n=276 109) comprising patients from the Myocardial Ischaemia National Audit Project (MINAP) between 2008 and 2013. The incidence of in-hospital CA for NSTE-ACS and non-ACS was lower in the SWEDEHEART-derivation cohort than in MINAP (1.3% and 0.5% vs. 2.3% and 2.3%). A seven point, five variable risk score (age ≥60 years (1 point), ST-T abnormalities (2 points), Killip Class >1 (1 point), heart rate Model discrimination was good in the derivation cohort (c-statistic 0.72) and temporal validation cohort (c-statistic 0.74), and calibration was reasonable with a tendency towards overestimation of risk with a higher sum of score points. External validation showed moderate discrimination (c-statistic 0.65) and calibration showed a general underestimation of predicted risk. A simple points score containing five variables readily available on admission predicts in-hospital CA for patients with suspected NSTE-ACS. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. 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.

  18. Timing of intervention in high-risk non-ST-elevation acute coronary syndromes in PCI versus non-PCI centres : Sub-group analysis of the ELISA-3 trial.

    Science.gov (United States)

    Badings, E A; Remkes, W S; Dambrink, J-H E; The, S H K; Van 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

    2016-03-01

    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. 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 an early invasive strategy than patients included in the PCI centre (relative risk 0.23 vs. 0.85 [p for interaction = 0.089] for incidence of the combined primary endpoint of death, reinfarction and recurrent ischaemia after 30 days of follow-up). This was largely driven by reduction in recurrent ischaemia. In non-PCI centres, patients randomised to the late group had a 4 and 7 day longer period until PCI or coronary artery bypass grafting, respectively. This difference was less pronounced in the PCI centre. This post-hoc analysis from the ELISA-3 trial suggests that NSTE-ACS patients initially hospitalised in non-PCI centres show the largest benefit from early angiography and revascularisation, associated with a shorter waiting time to revascularisation. Improved patient logistics and transfer between non-PCI and PCI centres might therefore result in better clinical outcome.

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

    Science.gov (United States)

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

    2016-01-01

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

  20. [Management of non-ST-segment-elevation acute coronary syndromes in Spain. The DESCARTES (Descripción del Estado de los Síndromes Coronarios Agudos en un Registro Temporal ESpañol) study].

    Science.gov (United States)

    Bueno, Héctor; Bardají, Alfredo; Fernández-Ortiz, Antonio; Marrugat, Jaume; Martí, Helena; Heras, Magda

    2005-03-01

    There is little information regarding the management of non-ST segment elevation acute coronary syndromes (NSTE ACS) in Spain from a population-based perspective. Our objective was to study the status of clinical care in patients with NSTE ACS in Spain from a representative perspective of the situation on a national level. A prospective registry was used for consecutive patients with NSTE ACS admitted to 52 Spanish hospitals with different cardiological facilities. Centers that fulfilled the quality control criteria for the study were randomly selected for inclusion. Between April and May, 2002, 1877 patients were recruited. Median age was 69 years, 93% had at least one risk factor and 73% had antecedents of cardiovascular disease. The electrocardiogram on admission was abnormal in 76% of the cases, and troponin levels were elevated in 53%. Twenty-seven percent of the patients were admitted to a cardiac care unit or intensive care unit. The rates of use of diagnostic techniques were: echocardiography 56%; non-invasive test for detection of ischemia 39%; coronary angiography 41%. During hospitalization, 24% underwent coronary revascularization, 88% received aspirin, 81% heparin, 37% clopidogrel, 12% glycoprotein IIb/IIIa inhibitors, 63% ss-blockers, 46% angiotensin-converting enzyme inhibitors, and 52% statins. The final diagnosis was angina in 54%, myocardial infarction in 28%, and other in 18%. Mortality was 3.7% at 28 days and 7.8% at 6 months. DESCARTES is the first representative registry of NSTE ACS management in Spain. It shows that despite their high-risk profile, these patients receive suboptimal medical care according to current clinical recommendations.

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    Background- Color tissue Doppler imaging M-mode through the mitral leaflet is an easy and precise method to estimate all cardiac time intervals from 1 cardiac cycle and thereby obtain the myocardial performance index (MPI). However, the prognostic value of the cardiac time intervals and the MPI...... assessed by color tissue Doppler imaging M-mode through the mitral leaflet in patients with ST-segment-elevation myocardial infarction (MI) is unknown. Methods and Results- In total, 391 patients were admitted with an ST-segment-elevation MI, treated with primary percutaneous coronary intervention...

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

    Directory of Open Access Journals (Sweden)

    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.

  3. 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.

  4. 10-Year Mortality Outcome of a Routine Invasive Strategy Versus a Selective Invasive Strategy in Non-ST-Segment Elevation Acute Coronary Syndrome: The British Heart Foundation RITA-3 Randomized Trial.

    Science.gov (United States)

    Henderson, Robert A; Jarvis, Christopher; Clayton, Tim; Pocock, Stuart J; Fox, Keith A A

    2015-08-04

    The RITA-3 (Third Randomised Intervention Treatment of Angina) trial compared outcomes of a routine early invasive strategy (coronary arteriography and myocardial revascularization, as clinically indicated) to those of a selective invasive strategy (coronary arteriography for recurrent ischemia only) in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). At a median of 5 years' follow-up, the routine invasive strategy was associated with a 24% reduction in the odds of all-cause mortality. This study reports 10-year follow-up outcomes of the randomized cohort to determine the impact of a routine invasive strategy on longer-term mortality. We randomized 1,810 patients with NSTEACS to receive routine invasive or selective invasive strategies. All randomized patients had annual follow-up visits up to 5 years, and mortality was documented thereafter using data from the Office of National Statistics. Over 10 years, there were no differences in mortality between the 2 groups (all-cause deaths in 225 [25.1%] vs. 232 patients [25.4%]: p = 0.94; and cardiovascular deaths in 135 [15.1%] vs. 147 patients [16.1%]: p = 0.65 in the routine invasive and selective invasive groups, respectively). Multivariate analysis identified several independent predictors of 10-year mortality: age, previous myocardial infarction, heart failure, smoking status, diabetes, heart rate, and ST-segment depression. A modified post-discharge Global Registry of Acute Coronary Events (GRACE) score was used to calculate an individual risk score for each patient and to form low-risk, medium-risk, and high-risk groups. Risk of death within 10 years varied markedly from 14.4 % in the low-risk group to 56.2% in the high-risk group. This mortality trend did not depend on the assigned treatment strategy. The advantage of reduced mortality of routine early invasive strategy seen at 5 years was attenuated during later follow-up, with no evidence of a difference in outcome at 10 years

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

    Science.gov (United States)

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

    2012-01-01

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

  6. Plasminogen activator inhibitor-1 5G/5G genotype is associated with early spontaneous recanalization of the infarct-related artery in patients presenting with acute ST-elevation myocardial infarction.

    Science.gov (United States)

    Cagliyan, Caglar E; Yuregir, Ozge O; Balli, Mehmet; Tekin, Kamuran; Akilli, Rabia E; Bozdogan, Sevcan T; Turkmen, Serdar; Deniz, Ali; Baykan, Oytun A; Aslan, Huseyin; Cayli, Murat

    2013-05-01

    We aimed to examine the association between plasminogen activator inhibitor-1 (PAI-1) genetic polymorphism and early spontaneous recanalization in patients presenting with acute ST-elevation myocardial infarction. Patients admitted to our emergency department with ST-elevation myocardial infarction in the first 6 h of symptom onset were included. An immediate primary percutaneous coronary intervention was performed. Patients were grouped according to the initial patency of the infarct-related artery (IRA) as follows: total occlusion (TO) group [Thrombolysis in Myocardial Infarction (TIMI) 0-1 flow in the IRA], partial recanalization group (TIMI 2 flow in the IRA), and complete recanalization (CR) group (TIMI 3 flow in the IRA). PAI-1 4G/5G polymorphism was detected using the real-time PCR method. There were 107 patients in the TO group, 30 patients in the partial recanalization group, and 45 patients in the CR group. When we evaluated degrees of patency according to the PAI-1 genotype, TO of the IRA was the highest in patients with the PAI 4G/4G genotype (PAI-1 4G/4G: 66.7%, PAI-1 4G/5G: 65.9%, PAI-1 5G/5G: 40.4%) and CR of the IRA was the highest in patients with the PAI 5G/5G genotype (PAI-1 5G/5G: 38.5%, PAI-1 4G/5G: 19.8%, PAI-1 4G/4G: 17.9%). The distribution of genotypes in different degrees of patency of IRA was statistically significant (P=0.029). In logistic regression analysis, the PAI-1 5G/5G genotype was associated independently with the spontaneous CR of the IRA (odds ratio: 2.875, 95% confidence interval [1.059-7.086], P=0.038). Patients with the PAI-1 5G/5G genotype seem to be luckier than others in terms of early spontaneous recanalization of the IRA. Further prospective studies with large patient populations are required for more precise results.

  7. Predicting ischemic mitral regurgitation in patients with acute ST-elevation myocardial infarction: Does time to reperfusion really matter and what is the role of collateral circulation?

    Science.gov (United States)

    Valuckiene, Zivile; Budrys, Povilas; Jurkevicius, Renaldas

    2016-01-15

    Ischemic mitral regurgitation (MR) is an adverse prognostic factor. We aimed to assess the role of time delay from symptom onset to reperfusion, and the impact of collateral circulation to incidence of MR in relation to established echocardiographic and clinical risk factors. Patients with STEMI presenting within 12 h from symptom onset and treated with primary percutaneous coronary intervention (PPCI) at Hospital of Lithuanian University of Health Sciences were enrolled. Echocardiography was performed after PPCI. Based on MR grade, patients were divided into no significant MR (NMR, grade 0-I MR, N = 102) and ischemic MR (IMR, grade ≥ 2 MR, N = 71) groups. Well-developed collaterals were defined as grade ≥ 2 by Rentrop classification. Continuous variables were compared by independent samples Student's T-test. Multivariate logistic regression analysis was used to identify independent predictors of ischemic MR. Time to reperfusion, MI localization, TIMI flow before/after PCI was similar between the groups. IMR group patients were elder, more often females and non-smokers, had lower body mass index, higher prevalence of multi-vessel coronary artery disease (CAD), better-developed collateral supply, greater left ventricular end-diastolic diameter index, left atrial index, pulmonary artery systolic pressure and lower ejection fraction. Multivariate logistic regression analysis revealed that ischemic MR is predicted by female gender, well-developed collateral supply, presence of multi-vessel CAD, and lower EF. In acute STEMI significant MR is unrelated to ischemic time and is predicted by female gender, lower EF, multi-vessel CAD and well-developed collateral supply to the infarct region.

  8. ST Elevation in aVR with Coexistent Multilead ST Depression

    Directory of Open Access Journals (Sweden)

    Benjamin Cooper

    2017-01-01

    Full Text Available History of present illness: An 80-year-old female with a history of Crohn’s disease presented to the emergency department with chest pain. She had two weeks of exertional chest pain that preceded an episode of chest pain immediately prior to arrival associated with diaphoresis. Her pain nearly completely resolved with sublingual nitroglycerin provided by pre-hospital personnel. She was hemodynamically stable with normal vital signs on arrival. An ECG was immediately obtained. Significant findings: The ECG shows ST-segment depressions in precordial leads V3 through V6, and limb leads I, II, and aVL, and 1 mm of ST-segment elevation in aVR. The initial troponin I was elevated at 1.37 ng/mL (upper limit of normal 0.40. Cardiology decided to delay catheterization until the next day when diffuse coronary disease was discovered (including 90% of the left circumflex stenosis, 60% proximal and 75% mid-left anterior descending stenosis, 75% third diagonal branch stenosis, and 90% posterior descending artery stenosis. The following day, the patient went to the operating room for coronary artery bypass grafting (CABG. Discussion: Traditionally, lead aVR has not received attention when interpreting acutely ischemic changes on ECG, leading some to refer to it as “the forgotten lead.”1 Current guidelines acknowledge the significance of multilead ST depression with coexistent ST elevation in aVR, and this pattern has been identified as the strongest predictor of severe left main coronary artery and/or 3-vessel disease (LM/3VD.2-3 When this ECG pattern is recognized in patients with ischemic symptoms, the emergency physician should involve cardiology early. When managing patients with suspected LM/3VD, it is important to withhold dual anti-platelet therapy as CABG is likely to be indicated,1,3 and guidelines recommend discontinuing P2Y12 inhibitors like clopidogrel or ticagrelor at least 24 hours prior to urgent CABG.2

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

    DEFF Research Database (Denmark)

    Hansen, Morten; Antonsen, L.; Jensen, L. O.

    2016-01-01

    A 28-year old man presented to the Emergency Department with malaise after cocaine intake. After arrival he developed retrosternal chest pain and the electrocardiogram showed ST segment elevations in V1-V2 and ST segment depressions in V5-V6. An acute coronary angiogram revealed a focal non...

  10. Interpretation of elevated plasma visfatin concentrations in patients with ST-elevation myocardial infarction.

    Science.gov (United States)

    Lu, Li-Fen; Wang, Chao-Ping; Yu, Teng-Hung; Hung, Wei-Chin; Chiu, Cheng-An; Chung, Fu-Mei; Tsai, I-Ting; Yang, Chih-Ying; Cheng, Ya-Ai; Lee, Yau-Jiunn; Yeh, Lee-Ren

    2012-01-01

    Visfatin is a cytokine that is expressed in many tissues, including the heart, and has been proposed to play a role in plaque destabilization leading to acute myocardial injury. The present study evaluates plasma levels of visfatin in acute ST-elevation myocardial infarction (STEMI) patients and examines the temporal changes in visfatin levels from the acute period to the subacute period to determine a correlation with the degree of myocardial ischemia. We evaluated 54 patients with STEMI. Circulating levels of visfatin and brain natriuretic peptide (BNP) were measured by ELISA. In addition, local expression of visfatin and BNP were detected by quantitative real-time polymerase chain reaction and immunohistochemical (IHC) analysis of left ventricular myocytes in a mouse model of myocardial infarction (MI). Plasma levels of visfatin were significantly increased in patients with STEMI on admission, relative to controls (effort angina patients and individuals without coronary artery disease). The visfatin levels reached a peak 24h after percutaneous coronary intervention (PCI) and then decreased toward the control range during the first week after PCI. The basal plasma visfatin levels were found to correlate with peak troponin-I, peak creatine kinase-MB, total white blood cell count, and BNP levels. Trend analyses confirmed that visfatin levels correlated with the number of diseased coronary arteries. Further, in MI mice, mRNA levels of visfatin and BNP were found to be higher than in sham-treated mice. IHC analysis showed that visfatin and BNP immunoreactivity was diffusely observable in left ventricular myocytes of the MI mice. This study indicates that plasma visfatin levels are significantly higher in STEMI patients and that these higher visfatin levels correlate with elevated levels of cardiac enzymes, suggesting that increased plasma visfatin may be closely related to the degree of myocardial damage. Copyright © 2011 Elsevier Ltd. All rights reserved.

  11. 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 with d...

  12. 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.

  13. The impact on persistent ST-segment elevation to the effect of direct percutaneous coronary intervention

    International Nuclear Information System (INIS)

    Yang Wei; Jin Huigen; Liu Zongjun; Wang Weiqing; Shi Jia; Wang Dongyi; Wang Daying; Zhu Huafang; Chen Yixun; Fang Ping; Chen Wenchun

    2005-01-01

    Objective: To discuss the value of persistent ST-segment elevation on infarct related leads of electrocardiogram to judge the effect of direct percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI). Methods: 229 AMI patients already been undertaken direct PCI with the flow of TIMI III were divided into two groups. According to the results of ST-segment elevation resolution on infarct related leads in electrocardiogram: the group of ST-segment elevation resolution more than 50% (group A) and the group of ST-segment elevation resolution less than 50%(group B). The basic clinical features between the two groups, and the followed up frequency of cardiac events were compared. Results: The comparisons between group A with group B showed: no-reflow as 14/147 (9.52%)VS 21/82 (25.61%); the mortality during in-hospital period 5/147 (3.40%)VS 9/82 (10.98%); MACE 8/147 (5.44%)VS 11/82 (13.4%); the value of LVEF 56.99%±9.78% VS 49.82%±8.78%, P 0.05, showing statistically insignificant. Conclusions: That the results of ST-segment elevation resolution on infarct related leads in electrocardiogram can be used as an index for reperfusion of myocardial tissue level and judgment of prognosis after direct PCI. (authors)

  14. Contemporary management of ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Yadlapati, Ajay; Gajjar, Mark; Schimmel, Daniel R; Ricciardi, Mark J; Flaherty, James D

    2016-12-01

    ST-elevation myocardial infarction (STEMI), which constitutes nearly 25-40 % of current acute myocardial infarction (AMI) cases, is a medical emergency that requires prompt recognition and treatment. Since the 2013 STEMI practice guidelines, a wealth of additional data that may further advance optimal STEMI practices has emerged. These data highlight the importance of improving patient treatment and transport algorithms for STEMI from non-primary percutaneous coronary intervention (PCI) centers. In addition, a focus on the reduction of total pain-to-balloon (P2B) times rather than simply door-to-balloon (D2B) times may further improve outcomes after primary PCI for STEMI. The early administration of newer oral P2Y12 inhibitors, including crushed forms of these agents for faster absorption, represents another treatment advancement. Recent data also suggest avoiding concurrent morphine use due to interactions with P2Y12 inhibitors. Furthermore, new technological advancements and investigational therapies, including Bioresorbable Vascular Scaffolds and the use of pre-intervention intravenous microbubbles with transthoracic ultrasound, hold promise to play a useful role in future STEMI care. Despite these advancements, the prompt recognition of STEMI, at both the patient and health care system level, remains the cornerstone of optimal treatment.

  15. 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...

  16. Reduction of st segment elevation in diabetic patients with myocardial infarction after thrombolytic therapy

    International Nuclear Information System (INIS)

    Syed, U.

    2017-01-01

    Acute coronary artery disease (CAD) is one of the main cause of death in today's world. Myocardial infarction (MI) tends to be more common among diabetic patients. One of the most effective and used (in our settings) methods of resolution of MI is administration of streptokinase (SK). This study was conducted with the aim to determine the efficacy of thrombolytic therapy in reduction of ST segment elevation in acute MI patients presenting with diabetes. Methods: A descriptive case series with selection of 130 patients through non-probability purposive sampling was conducted at the Medical Departments of Services Hospital Lahore. The study was completed in 6 Months. Patients 18-80 years of age having either gender diagnosed with confirmed acute myocardial infarction were included in this study. All patients were then injected with streptokinase 1.5 mu. Pre and Post SK ECGs were done and ST segment elevation measured also measuring reduction of ST segment. Results: The mean age of the patients was noted as 54.42+-8.80 years. There were 62.31% males. Mean reduction in ST-segment elevation of the patients was noted as 58.53+-26.01. The efficacy was achieved in 47.7% patients. Conclusion: It is concluded that SK can be effective in almost half of diabetic patients with myocardial infarction. (author)

  17. [Quality indicators for the assessment of ST-segment elevation acute myocardial infarction (STEMI) networks. How hospital discharge records could be integrated with Emergency medical services data: the Emilia-Romagna STEMI network experience].

    Science.gov (United States)

    Pavesi, Pier Camillo; Guastaroba, Paolo; Casella, Gianni; Berti, Elena; De Palma, Rossana; Di Bartolomeo, Stefano; Di Pasquale, Giuseppe

    2015-09-01

    The assessment of the regional network for ST-segment elevation acute myocardial infarction (STEMI) is fundamental for quality assurance. Since 2011 all Italian Health Authorities, in addition to hospital discharge records (HDR), must provide a standardized information flow (ERD) about emergency department (ED) and emergency medical system (EMS) activities. The aim of this study was to evaluate whether data integration of ERD with HDR may allow the development of appropriate quality indicators. Patients admitted to coronary care units (CCU) for STEMI between January 1 to December 31, 2013, were identified from the regional HDR database. All data were linked to those of the regional ERD database. Four quality indicators were defined: 1) rates of EMS activation, 2) rates of EMS direct transfer to the catheterization laboratory (Cath-lab), 3) transfer rates from a Spoke to a Hub hospital with angioplasty facilities, and 4) median time spent in ED. In 2013, 2793 patients with STEMI were admitted to the CCU. Of these, 1684 patients (60%) activated EMS and were transported to Spoke or Hub hospitals; 955 (57%) entered directly in CCU/Cath-lab; 677 were transferred directly to a Hub hospital ED without being admitted to a Spoke hospital. The median ED time in Hub hospital was 47 min (IQR 24-136) and in Spoke hospital 53 min (IQR 30-131). The integration among administrative data banks (i.e., HDR with ERD) allowed the assessment of the regional STEMI network and the identification of potentially useful quality indicators. Their easy availability should enable comparisons with local, national and international standards, and may favor quality improvement.

  18. Comparison of the American College of Cardiology/American Heart Association and the European Society of Cardiology guidelines for the management of patients with non-ST-segment elevation acute coronary syndromes.

    Science.gov (United States)

    Alame, Aya J; Karatasakis, Aris; Karacsonyi, Judit; Danek, Barbara A; Resendes, Erica; Martinez Parachini, Jose R; Kalsaria, Pratik; Roesle, Michele; Rangan, Bavana V; Sorajja, Paul; Jneid, Hani; Banerjee, Subhash; Brilakis, Emmanouil S

    2017-06-01

    The American College of Cardiology (ACC), the American Heart Association (AHA), and the European Society of Cardiology (ESC) have been developing guidelines to assist clinicians in making evidence-based decisions. The current ACC/AHA and ESC guidelines for non-ST-segment elevation acute coronary syndromes (NSTE-ACS) that were updated in 2014 and 2015, respectively, were compared to assess the number of recommendations on the basis of class of recommendation and level of evidence (LOE), the sources cited, and the content. The total number of recommendations in the ACC/AHA and ESC guidelines was 182 and 147, respectively. The recommendation class distribution of the ACC/AHA guidelines was 61.0% class I (compared with 61.9% in the ESC guidelines, P=0.865), 29.7% class II (compared with 32.0% in the ESC guidelines, P=0.653), and 9.3% class III (compared with 6.1% in the ESC guidelines, P=0.282). The LOE distribution among ACC/AHA guidelines was 15.9% LOE A (compared with 27.9% in the ESC guidelines, P=0.008), 50.0% LOE B (compared with 33.3% in the ESC guidelines, P=0.002), and 34.1% LOE C (compared with 38.8% in the ESC guidelines, P=0.377). The ACC/AHA guidelines cited 827 publications and the ESC guidelines cited 551 publications, 124 of which were shared by both sets of guidelines. The guidelines' approaches to NSTE-ACS were consistent, with minor differences in diagnostic and medical therapy recommendations. Overall, the ACC/AHA and ESC guidelines contain a comparable number of recommendations and provide similar guidance for the management of patients with NSTE-ACS.

  19. Invasive Management Strategies and Antithrombotic Treatments in Patients With Non-ST-Segment-Elevation Acute Coronary Syndrome in China: Findings From the Improving CCC Project (Care for Cardiovascular Disease in China).

    Science.gov (United States)

    Yang, Qing; Wang, Ying; Liu, Jing; Liu, Jun; Hao, Yongchen; Smith, Sidney C; Huo, Yong; Fonarow, Gregg C; Ma, Changsheng; Ge, Junbo; Taubert, Kathryn A; Morgan, Louise; Guo, Yang; Wang, Wei; Zhou, Yujie; Zhao, Dong

    2017-06-01

    Early invasive strategies and antithrombotic treatments are key treatments of non-ST-segment-elevation acute coronary syndrome (NSTE-ACS). Few studies have examined the use of these strategies in patients with NSTE-ACS in China. This study aimed to assess the applications of invasive strategies and antithrombotic treatments in patients with NSTE-ACS and compare their outcomes. A nationwide registry study, Improving CCC (Care for Cardiovascular Disease in China) ACS project, was launched in 2014 as a collaborative study of the American Heart Association and Chinese Society of Cardiology (CSC), with 142 participating hospitals reporting details of clinical management and outcomes of patients with NSTE-ACS. The use of invasive strategies and antithrombotic treatments was examined based on updated guidelines. Major adverse cardiovascular events were analyzed. A total of 9953 patients with NSTE-ACS were enrolled. Angiography was performed in 63.1% of these patients, and 58.2% underwent percutaneous coronary intervention (PCI). However, 40.6% of patients did not undergo early risk assessment, and very-high-risk patients had the lowest proportion of PCI (41.7%). PCI was performed within recommended times in 11.1% of very-high-risk patients and 26.3% of high risk patients. Those who underwent PCI within 2 hours had higher mortality in high-risk and very-high-risk patients who received PCI. Early dual antiplatelet treatment was given in 88.3% of patients. There are notable differences between guideline recommendations and the clinical management of patients with NSTE-ACS in China. The reasons for very-high-risk NSTE-ACS patients not undergoing PCI, and the optimal timing of PCI, require further clarification. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02306616. © 2017 American Heart Association, Inc.

  20. Contemporary Patterns of Early Coronary Angiography Use in Patients With Non-ST-Segment Elevation Myocardial Infarction in the United States: Insights From the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry.

    Science.gov (United States)

    Malta Hansen, Carolina; Wang, Tracy Y; Chen, Anita Y; Chiswell, Karen; Bhatt, Deepak L; Enriquez, Jonathan R; Henry, Timothy; Roe, Matthew T

    2018-02-26

    The study sought to characterize patient- and hospital-level variation in early angiography use among non-ST-segment elevation myocardial infarction (NSTEMI) patients. Contemporary implementation of guideline recommendations for early angiography use in NSTEMI patients in the United States have not been described. The study analyzed NSTEMI patients included in ACTION (Acute Coronary Treatment and Intervention Outcomes Network) registry (2012 to 2014) who underwent in-hospital angiography. Timing of angiography was categorized as early (≤24 h) vs. delayed (>24 h). The study evaluated factors associated with early angiography, hospital-level variation in early angiography use, and the relationship with quality-of-care measures. A total of 79,760 of 138,688 (57.5%) patients underwent early angiography. Factors most strongly associated with delayed angiography included weekend or holiday presentation, lower initial troponin ratio values, higher initial creatinine values, heart failure on presentation, and older age. Median hospital-level use of early angiography was 58.5% with wide variation across hospitals (21.7% to 100.0%). Patient characteristics did not differ substantially across hospitals grouped by tertiles of early angiography use (low, middle, and high). Hospitals in the highest tertile tended to more commonly use guideline-recommended medications and had higher defect-free care quality scores. In contemporary U.S. practice, high-risk clinical characteristics were associated with lower use of early angiography in NSTEMI patients; hospital-level use of early angiography varied widely despite few differences in case mix. Hospitals that most commonly utilized early angiography also had higher quality-of-care metrics, highlighting the need for improved NSTEMI guideline adherence. Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  1. Design and Rationale for the Endothelin-1 Receptor Antagonism in the Prevention of Microvascular Injury in Patients with non-ST Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention (ENDORA-PCI) Trial.

    Science.gov (United States)

    Liou, Kevin; Jepson, Nigel; Buckley, Nicolas; Chen, Vivien; Thomas, Shane; Russell, Elizabeth Anne; Ooi, Sze-Yuan

    2016-04-01

    Peri-procedural myocardial infarction (PMI) occurs in a small but significant portion of patients undergoing percutaneous intervention (PCI). The underlying mechanisms are complex and may include neurohormonal activation and release of vasoactive substances resulting in disruption of the coronary microcirculation. Endothelin in particular has been found in abundance in atherosclerotic plaques and in systemic circulation following PCI, and may be a potential culprit for PMI through its action on microvascular vasoconstriction, and platelet and neutrophil activation. In this study we aim to characterize the behavior of the coronary microcirculation during a PCI with the index of microvascular resistance (IMR) and the effect of peri-procedural endothelin antagonism. The ENDORA-PCI trial is a randomized, double-blind, placebo-controlled, single-center clinical trial designed to evaluate the efficacy of endothelin antagonism in attenuating the peri-procedural rise in IMR as a surrogate marker for PMI. The patients of interest are those with non-ST elevation acute coronary syndrome (NSTEACS) undergoing PCI, and we aim to recruit 52 patients overall to give the study a power of 80 % at an α level of 5 %. Patients will be randomized in a 1:1 fashion to either Ambrisentan, an endothelin antagonist, or placebo, prior to their PCI. IMR will be measured before and after PCI. The primary endpoint is the difference in peri-procedural changes in patients' IMR between the two groups. The ENDORA-PCI study will investigate whether endothelin antagonism with Ambrisentan attenuates the peri-procedural rise in IMR in patients with NSTEACS undergoing PCI, and thus potentially the risk of PMI.

  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. ST–Segment elevation: Not always an acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    Érico Costa

    2017-01-01

    Full Text Available Cardiac tumors can be primary or metastatic, the latter being more frequent and usually of pulmonary or hematologic origin. These patients’ clinical signs are non-specific and the electrocardiogram (ECG can assume many patterns, among which, ST-segment elevation. Nevertheless, associated occlusion of the coronary arteries is rare in these situations.We present a 79-year-old woman with a history of pulmonary neoplasia who was admitted to the emergency department due to atypical chest pain, cough and worsening dyspnea in the previous 3 days. The ECG revealed an ST-segment elevation in the anterolateral and inferolateral leads, despite normal blood work, namely normal troponin. Due to the disparity between the patient’s symptoms and the ECG findings, a decision was made not to proceed to primary angioplasty, but to further investigate with echocardiography, which revealed a mass localized in the anterolateral and inferolateral left ventricle walls, confirmed by computed tomography. The patient was admitted in the medical ward for symptomatic management. Her clinical condition gradually deteriorated due to the disease’s natural evolution and she died two weeks later.This case highlights the importance to keep in mind differential diagnoses to acute coronary syndromes, when a ST-segment elevation is encountered on an ECG.

  4. Haemodynamic patterns in ST-elevation myocardial infarction : incidence and correlates of elevated filling pressures

    NARCIS (Netherlands)

    Bergstra, A.; Svilaas, T.; van Veldhuisen, D. J.; van den Heuvel, A. F. M.; van der Horst, I. C. C.; Zijlstra, F.

    Objectives. We sought to study the incidence and clinical correlates of elevated filling pressures in ST-elevation myocardial infarction (STEMI) patients, without physical signs of heart failure and treated with primary coronary angioplasty. Background. Haemodynamic data, as measured with a

  5. Correlation of Admission Heart Rate With Angiographic and Clinical Outcomes in Patients With Right Coronary Artery ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: HORIZONS-AMI (The Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) Trial.

    Science.gov (United States)

    Kosmidou, Ioanna; McAndrew, Thomas; Redfors, Björn; Embacher, Monica; Dizon, José M; Mehran, Roxana; Ben-Yehuda, Ori; Mintz, Gary S; Stone, Gregg W

    2017-07-19

    Bradycardia on presentation is frequently observed in patients with right coronary artery ST-segment elevation myocardial infarction, but it is largely unknown whether it predicts poor angiographic or clinical outcomes in that patient population. We sought to determine the prognostic implications of admission heart rate (AHR) in patients with ST-segment elevation myocardial infarction and a right coronary artery culprit lesion. We analyzed 1460 patients with ST-segment elevation myocardial infarction and a right coronary artery culprit lesion enrolled in the randomized HORIZONS-AMI (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction) trial who underwent primary percutaneous coronary intervention. Patients presenting with high-grade atrioventricular block were excluded. Outcomes were examined according to AHR range (AHR 100 beats per minute). Angiographic analysis showed no significant association between AHR and lesion location or complexity. On multivariate analysis, admission bradycardia (AHR ST-segment elevation myocardial infarction and a right coronary artery culprit lesion undergoing primary percutaneous coronary intervention, admission bradycardia was not associated with increased mortality or major adverse cardiac events at 1 year. URL: https://www.clinicaltrials.gov. Unique identifier: NCT00433966. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  6. Cocaine use is associated with a higher prevalence of elevated ST2 concentrations.

    Science.gov (United States)

    van Wijk, Xander M R; Vittinghoff, Eric; Wu, Alan H B; Lynch, Kara L; Riley, Elise D

    2017-09-01

    Cocaine is a well-known risk factor for acute cardiac events, but the effects in users outside of acute events are less clear. We investigated a possible association between cocaine use and the concentration of a novel biomarker for cardiac stress and heart failure, ST2. A case-control study was conducted to compare ST2 concentrations by the presence of cocaine in patients presenting for care, but not cardiac care, at an urban safety net hospital. In samples taken from 100 cocaine-positive and 100 cocaine-negative patients, the presence of cocaine was associated with ST2 concentrations>35ng/mL. Serum concentrations of benzoylecgonine, a major cocaine metabolite, were significantly correlated with ST2 concentrations. Cocaine use is associated with subclinical cardiac stress and damage outside of acute cardiac events. This information could add to better stratification of cocaine users with elevated ST2 concentrations who may be at higher risk for developing heart failure and other cardiac complications. Copyright © 2017 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  7. Relation between thoracic aortic inflammation and features of plaque vulnerability in the coronary tree in patients with non-ST-segment elevation acute coronary syndrome undergoing percutaneous coronary intervention. An FDG-positron emission tomography and optical coherence tomography study

    Energy Technology Data Exchange (ETDEWEB)

    Taglieri, Nevio; Ghetti, Gabriele; Saia, Francesco; Bacchi Reggiani, Maria Letizia; Rapezzi, Claudio [Alma Mater Studiorum Universita di Bologna, Istituto di Cardiologia, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Bologna (Italy); Nanni, Cristina; Bonfiglioli, Rachele; Lima, Giacomo Maria; Fanti, Stefano [Alma Mater Studiorum Universita di Bologna, Istituto di Medicina Nucleare, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Bologna (Italy); Marco, Valeria [CLI Foundation, Rome (Italy); Prati, Francesco [CLI Foundation, Rome (Italy); Ettore Sansavini Health Science Foundation, GVM Care and Research, Cotignola (Italy)

    2017-10-15

    To evaluate the relationship between aortic inflammation as assessed by {sup 18}F-fluorodeoxyglucose-positron emission tomography ({sup 18}F-FDG-PET) and features of plaque vulnerability as assessed by frequency domain-optical coherence tomography (FD-OCT). We enrolled 30 consecutive non-ST-segment elevation acute coronary syndrome patients undergoing percutaneous coronary intervention. All patients underwent three-vessel OCT before intervention and {sup 18}F-FDG-PET before discharge. Univariable and C-reactive protein (CRP)-adjusted linear regression analyses were performed between features of vulnerability [namely:lipid-rich plaques with and without macrophages and thin cap fibroatheromas (TCFA)] and {sup 18}F-FDG uptake in both ascending (AA) and descending aorta (DA) [measured either as averaged mean and maximum target-to-blood ratio (TBR) or as active slices (TBR{sub max} ≥ 1.6)]. Mean age was 62 years, and 26 patients were male. On univariable linear regression analysis TBR{sub mean} and TBR{sub max} in DA was associated with the number of lipid-rich plaques (β = 4.22; 95%CI 0.05-8.39; p = 0.047 and β = 3.72; 95%CI 1.14-6.30; p = 0.006, respectively). TBR{sub max} in DA was also associated with the number of lipid-rich plaques containing macrophages (β = 2.40; 95%CI 0.07-4.72; p = 0.044). A significant CRP adjusted linear association between the TBR{sub max} in DA and the number of lipid-rich plaques was observed (CRP-adjusted β = 3.58; 95%CI -0.91-6.25; p = 0.01). TBR{sub max} in DA showed a trend towards significant CRP-adjusted association with number of lipid-rich plaques with macrophages (CRP-adjusted β = 2.30; 95%CI -0.11-4.71; p = 0.06). We also observed a CRP-adjusted (β = 2.34; 95%CI 0.22-4.47; p = 0.031) linear association between the number of active slices in DA and the number of lipid-rich plaques. No relation was found between FDG uptake in the aorta and the number of TCFAs. In patients with first NSTEACS{sup ,} {sup 18}F-FDG uptake in

  8. 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

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

    Science.gov (United States)

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

    2012-02-01

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

  10. 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...... minutes after revascularisation. ST peak was defined as ≥1 mm increase in the ST-segment during PCI compared with the ST elevation before intervention. ST peak was observed in 26.9% of patients. During median follow-up of 4.1 years, 20.7% of patients experienced a major adverse cardiac event (MACE). ST...... and ST peak including ST resolution and epicardial flow, ST peak remained significantly associated with MACE: adjusted hazard ratio (HR) 1.40 (95% confidence interval [CI] 1.01-1.95) and 1.41 (95% CI: 1.02-1.96). CONCLUSIONS: In the largest study hitherto evaluating the ST peak phenomenon during primary...

  11. Background and design of the ACCA-EAPCI registry on ST-segment elevation myocardial infarction of the European Society of Cardiology.

    Science.gov (United States)

    Zeymer, Uwe; Ludman, Peter; Danchin, Nicolas; Kala, Petr; Maggioni, Aldo P; Weidinger, Franz

    2018-02-01

    Treatment of patients with acute ST-segment elevation myocardial infarction has improved over past decades, with reperfusion therapy being the cornerstone in the acute phase. Based on the results of large randomised trials the current ST-segment elevation myocardial infarction guidelines of the European Society of Cardiology (ESC) recommend acute treatments and secondary prevention therapies. However, there are large variations between ESC countries in the treatment of patients presenting with ST-segment elevation myocardial infarction. Therefore the ESC has initiated a prospective registry to evaluate the current treatments and outcomes of these patients with a special focus on adherence to the ESC guidelines and on differences between countries and regions. This paper describes the methodology and design of the ST-segment elevation myocardial infarction registry conducted in collaboration of the Acute Cardiac Care Association and the European Association of Percutaneous Coronary Intervention.

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    Hyperglycemia upon hospital admission in patients with ST-segment elevation myocardial infarction (STEMI) occurs frequently and is associated with adverse outcomes. It is, however, unsettled as to whether an elevated blood glucose level is the cause or consequence of increased myocardial damage....... In addition, whether the cardioprotective effect of exenatide, a glucose-lowering drug, is dependent on hyperglycemia remains unknown. The objectives of this substudy were to evaluate the association between hyperglycemia and infarct size, myocardial salvage, and area at risk, and to assess the interaction...... between exenatide and hyperglycemia. A total of 210 STEMI patients were randomized to receive intravenous exenatide or placebo before percutaneous coronary intervention. Hyperglycemia was associated with larger area at risk and infarct size compared with patients with normoglycemia, but the salvage index...

  13. Impact of metabolic syndrome on ST segment resolution after thrombolytic therapy for acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Ayşe Saatçı Yaşar

    2010-09-01

    Full Text Available Objectives: It has been shown that metabolic syndrome is associated with poor short-term outcome and poor long-term survival in patients with acute myocardial infarction. We aimed to investigate the effect of metabolic syndrome on ST segment resolution in patients received thrombolytic therapy for acute myocardial infarction.Materials and methods: We retrospectively analyzed 161 patients, who were admitted to our clinics with acute ST-elevated-myocardial infarction and received thrombolytic therapy within 12 hours of chest pain. Metabolic syndrome was diagnosed according to National Cholesterol Education Program Adult Treatment Panel III criteria. Resolution of ST segment elevation was assessed on the baseline and 90-minute electrocardiograms. ST segment resolution ≥70% was defined as complete resolution.Results: Metabolic syndrome was found in 56.5% of patients. The proportion of patients with metabolic syndrome who achieved complete ST segment resolution after thrombolysis was significantly lower than that of patients without metabolic syndrome (32.9% versus 58.6%, p=0.001. On multivariate analysis metabolic syndrome was the only independent predictor of ST segment resolution (p=0.01, Odds ratio=2.543, %95 CI:1.248-5.179Conclusion: The patients with metabolic syndrome had lower rates of complete ST segment resolution after thrombolytic therapy for acute myocardial infarction. This finding may contribute to the higher morbidity and mortality of patients with metabolic syndrome.

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

    Science.gov (United States)

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

    2012-01-31

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

  15. Early Stent Thrombosis and Mortality After Primary Percutaneous Coronary Intervention in ST-Segment-Elevation Myocardial Infarction

    DEFF Research Database (Denmark)

    Dangas, George D; Schoos, Mikkel M.; Steg, Philippe Gabriel

    2016-01-01

    BACKGROUND: Early stent thrombosis (ST) within 30 days after primary percutaneous coronary intervention in ST-segment-elevation myocardial infarction is a serious event. We sought to determine the predictors of and risk of mortality after early ST according to procedural antithrombotic therapy...... with bivalirudin compared with heparin±GPI because of increased ST within 4 hours after primary percutaneous coronary intervention. However, the mortality attributable to early ST was significantly lower after bivalirudin than after heparin±GPI. CLINICAL TRIAL REGISTRATION: URL: http....... METHODS AND RESULTS: In a patient-level pooled analysis from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) and European Ambulance Acute Coronary Syndrome Angiography (EUROMAX) trials, we examined 30-day outcomes in 4935 patients undergoing primary...

  16. ST-segment elevation and ventricular tachycardia after ingestion of a common ornamental plant—a case report

    Directory of Open Access Journals (Sweden)

    Rami A. Jambeih

    2012-03-01

    This case highlights the importance of public awareness of severe toxicity from Japanese yew or other yew plants. Yews contain taxines that are responsible for the ECG abnormalities due to its inhibitory effect on the cardiac sodium and calcium channels. They cause conduction abnormalities, VT, and ST-segment elevation that can resemble acute myocardial infarction, hyperkalaemia, and Brugada syndrome.

  17. Changes in myocardial blood flow and S-T segment elevation following coronary artery occlusion in dogs

    International Nuclear Information System (INIS)

    Smith, H.J.; Singh, B.N.; Norris, R.M.; John, M.B.; Hurley, P.J.

    1975-01-01

    The relationship between regional blood flow and epicardial S-T segment elevation was studied in 26 open-chest anesthetized dogs with left anterior coronary artery ligations. Changes in myocardial blood flow, measured with 15 +- 5 μ (diameter) microspheres labeled with 141 Ce, 85 Sr, and 169 Yb, were correlated with summated S-T segment elevations 15 minutes, 1 hour, and 2 hours after coronary artery occlusion. In normal areas, myocardial blood flow was 113 +- 5 ml/min 100 g -1 and summated S-T segment elevation was 0.3 +- 0.2 mv. Fifteen minutes after coronary artery occlusion in 26 dogs, S-T segment elevation was 5.7 +- 0.7 mv over the center of the infarct and myocardial blood flow was 10 +- 1 ml/min 100 g -1 ; over the border zone, myocardial blood flow was 63 +- 4 ml/min 100 g -1 and S-T segment elevation was 3.1 +- 0.1 mv. One third of the areas with a myocardial blood flow of 10 ml/min 100 g -1 or less had no S-T segment elevation. In the center and border zones of the infarct in 9 dogs, myocardial blood flow increased from 11 +- 2 and 67 +- 8 ml/min 100 g -1 15 minutes after occlusion to 20 +- 4 and 84 +- 12 ml/min 100 g -1 , respectively, 2 hours after coronary artery occlusion. These increases were not associated with a significant reduction in summated S-T segment elevation. The results do not suggest a simple quantitative relationship between epicardial S-T segment elevation and myocardial blood flow following acute coronary artery occlusion

  18. ST-segment elevation myocardial infarction treated with thrombolytic therapy in a patient with thrombotic thrombocytopenic purpura.

    Science.gov (United States)

    Doll, Jacob A; Kelly, Jacob P

    2014-07-01

    Acute myocardial infarction is a common complication of thrombotic thrombocytopenic purpura (TTP), but rarely the presenting manifestation. Anti-thrombotic therapy for myocardial infarction is rarely utilized in the setting of TTP because of elevated bleeding risk. We report a case of TTP presenting with ST-segment elevation myocardial infarction and treated with thrombolytic therapy. The resultant cardiac and neurological complications highlight the challenges of using evidence-based therapy for myocardial infarction in the setting of TTP.

  19. Chameleons: Electrocardiogram Imitators of ST-Segment Elevation Myocardial Infarction.

    Science.gov (United States)

    Nable, Jose V; Lawner, Benjamin J

    2015-08-01

    The imperative for timely reperfusion therapy for patients presenting with ST-segment elevation myocardial infarction (STEMI) underscores the need for clinicians to have an understanding of how to distinguish patterns of STEMI from its imitators. These imitating diagnoses may confound an evaluation, potentially delaying necessary therapy. Although numerous diagnoses may mimic STEMI, several morphologic clues may allow the physician to determine if the pattern is concerning for either STEMI or a mimicking diagnosis. Furthermore, obtaining a satisfactory history, comparing previous electrocardiograms, and assessing serial tests may provide valuable clues. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Comparison of newer-generation drug-eluting with bare-metal stents in patients with acute ST-segment elevation myocardial infarction: a pooled analysis of the EXAMINATION (clinical Evaluation of the Xience-V stent in Acute Myocardial INfArcTION) and COMFORTABLE-AMI (Comparison of Biolimus Eluted From an Erodible Stent Coating With Bare Metal Stents in Acute ST-Elevation Myocardial Infarction) trials.

    Science.gov (United States)

    Sabaté, Manel; Räber, Lorenz; Heg, Dik; Brugaletta, Salvatore; Kelbaek, Henning; Cequier, Angel; Ostojic, Miodrag; Iñiguez, Andrés; Tüller, David; Serra, Antonio; Baumbach, Andreas; von Birgelen, Clemens; Hernandez-Antolin, Rosana; Roffi, Marco; Mainar, Vicente; Valgimigli, Marco; Serruys, Patrick W; Jüni, Peter; Windecker, Stephan

    2014-01-01

    This study sought to study the efficacy and safety of newer-generation drug-eluting stents (DES) compared with bare-metal stents (BMS) in an appropriately powered population of patients with ST-segment elevation myocardial infarction (STEMI). Among patients with STEMI, early generation DES improved efficacy but not safety compared with BMS. Newer-generation DES, everolimus-eluting stents, and biolimus A9-eluting stents, have been shown to improve clinical outcomes compared with early generation DES. Individual patient data for 2,665 STEMI patients enrolled in 2 large-scale randomized clinical trials comparing newer-generation DES with BMS were pooled: 1,326 patients received a newer-generation DES (everolimus-eluting stent or biolimus A9-eluting stent), whereas the remaining 1,329 patients received a BMS. Random-effects models were used to assess differences between the 2 groups for the device-oriented composite endpoint of cardiac death, target-vessel reinfarction, and target-lesion revascularization and the patient-oriented composite endpoint of all-cause death, any infarction, and any revascularization at 1 year. Newer-generation DES substantially reduce the risk of the device-oriented composite endpoint compared with BMS at 1 year (relative risk [RR]: 0.58; 95% confidence interval [CI]: 0.43 to 0.79; p = 0.0004). Similarly, the risk of the patient-oriented composite endpoint was lower with newer-generation DES than BMS (RR: 0.78; 95% CI: 0.63 to 0.96; p = 0.02). Differences in favor of newer-generation DES were driven by both a lower risk of repeat revascularization of the target lesion (RR: 0.33; 95% CI: 0.20 to 0.52; p stent thrombosis (RR: 0.35; 95% CI: 0.16 to 0.75; p = 0.006) compared with BMS. Among patients with STEMI, newer-generation DES improve safety and efficacy compared with BMS throughout 1 year. It remains to be determined whether the differences in favor of newer-generation DES are sustained during long-term follow-up. Copyright © 2014 American

  1. Impact of iso-osmolar versus low-osmolar contrast agents on contrast-induced nephropathy and tissue reperfusion in unselected patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (from the Contrast Media and Nephrotoxicity Following Primary Angioplasty for Acute Myocardial Infarction [CONTRAST-AMI] Trial).

    Science.gov (United States)

    Bolognese, Leonardo; Falsini, Giovanni; Schwenke, Carsten; Grotti, Simone; Limbruno, Ugo; Liistro, Francesco; Carrera, Arcangelo; Angioli, Paolo; Picchi, Andrea; Ducci, Kenneth; Pierli, Carlo

    2012-01-01

    Conflicting data have been reported on the effects of low-osmolar and iso-osmolar contrast media on contrast-induced acute kidney injury (CI-AKI). In particular, no clinical trial has yet focused on the effect of contemporary contrast media on CI-AKI, epicardial flow, and microcirculatory function in patients with ST-segment elevation acute myocardial infarction who undergo primary percutaneous coronary intervention. The Contrast Media and Nephrotoxicity Following Coronary Revascularization by Angioplasty for Acute Myocardial Infarction (CONTRAST-AMI) trial is a prospective, randomized, single-blind, parallel-group, noninferiority study aiming to evaluate the effects of the low-osmolar contrast medium iopromide compared to the iso-osmolar agent iodixanol on CI-AKI and tissue-level perfusion in patients with ST-segment elevation acute myocardial infarction. Four hundred seventy-five consecutive, unselected patients who underwent primary percutaneous coronary intervention were randomized to iopromide (n = 239) or iodixanol (n = 236). All patients received high-dose N-acetylcysteine and hydration. The primary end point was the proportion of patients with serum creatinine (sCr) increases ≥25% from baseline to 72 hours. Secondary end points were Thrombolysis In Myocardial Infarction (TIMI) myocardial perfusion grade, increase in sCr ≥50%, increase in sCr ≥0.5 or ≥1 mg/dl, and 1-month major adverse cardiac events. The primary end point occurred in 10% of the iopromide group and in 13% of the iodixanol group (95% confidence interval -9% to 3%, p for noninferiority = 0.0002). A TIMI myocardial perfusion grade of 0 or 1 was present in 14% of patients in the 2 groups. No differences between the 2 groups were found in any of the secondary analyses of sCr increase. No significant difference in 1-month major adverse cardiac events was found (8% vs 6%, p = 0.37). In conclusion, in a population of unselected patients with ST-segment elevation acute myocardial infarction

  2. Frequency of diabetes in non st elevation myocardial infarction

    International Nuclear Information System (INIS)

    Rafiq, I.; Khan, A.N.

    2017-01-01

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

  3. 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

  4. Remote Zone Extracellular Volume and Left Ventricular Remodeling in Survivors of ST-Elevation Myocardial Infarction

    Science.gov (United States)

    Carberry, Jaclyn; Carrick, David; Haig, Caroline; Rauhalammi, Samuli M.; Ahmed, Nadeem; Mordi, Ify; McEntegart, Margaret; Petrie, Mark C.; Eteiba, Hany; Hood, Stuart; Watkins, Stuart; Lindsay, Mitchell; Davie, Andrew; Mahrous, Ahmed; Ford, Ian; Sattar, Naveed; Welsh, Paul; Radjenovic, Aleksandra; Oldroyd, Keith G.

    2016-01-01

    The natural history and pathophysiological significance of tissue remodeling in the myocardial remote zone after acute ST-elevation myocardial infarction (STEMI) is incompletely understood. Extracellular volume (ECV) in myocardial regions of interest can now be measured with cardiac magnetic resonance imaging. Patients who sustained an acute STEMI were enrolled in a cohort study (BHF MR-MI [British Heart Foundation Magnetic Resonance Imaging in Acute ST-Segment Elevation Myocardial Infarction study]). Cardiac magnetic resonance was performed at 1.5 Tesla at 2 days and 6 months post STEMI. T1 modified Look-Locker inversion recovery mapping was performed before and 15 minutes after contrast (0.15 mmol/kg gadoterate meglumine) in 140 patients at 2 days post STEMI (mean age: 59 years, 76% male) and in 131 patients at 6 months post STEMI. Remote zone ECV was lower than infarct zone ECV (25.6±2.8% versus 51.4±8.9%; Premote zone ECV (Premote zone ECV (P=0.010). No ST-segment resolution (P=0.034) and extent of ischemic area at risk (Premote zone ECV at 6 months (ΔECV). ΔECV was a multivariable associate of the change in left ventricular end-diastolic volume at 6 months (regression coefficient [95% confidence interval]: 1.43 (0.10–2.76); P=0.036). ΔECV is implicated in the pathophysiology of left ventricular remodeling post STEMI, but because the effect size is small, ΔECV has limited use as a clinical biomarker of remodeling. Clinical Trial Registration— URL: https://www.clinicaltrials.gov. Unique identifier: NCT02072850. PMID:27354423

  5. Predictive value of elevated cystatin C in patients undergoing primary angioplasty for ST-elevation myocardial infarction.

    Science.gov (United States)

    Akgul, Ozgur; Uyarel, Huseyin; Ergelen, Mehmet; Pusuroglu, Hamdi; Gul, Mehmet; Turen, Selahattin; Bulut, Umit; Baycan, Omer Faruk; Ozal, Ender; Cetin, Mustafa; Yıldırım, Aydın; Uslu, Nevzat

    2013-10-01

    The prognostic value of cystatin C (CysC) has been documented in patients with acute coronary syndrome without ST-segment elevation. However, its value in acute ST-segment elevation myocardial infarction (STEMI) remains unclear. The aim of this study was to evaluate the prognostic value of CysC in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). We prospectively enrolled 475 consecutive STEMI patients (mean age 55.6±12.4 years, 380 male, 95 female) undergoing primary PCI. The study population was divided into tertiles based on admission CysC values. The high CysC group (n=159) was defined as a value in the third tertile (>1.12 mg/L), and the low CysC group (n=316) included those patients with a value in the lower two tertiles (≤1.12 mg/L). Clinical characteristics and in-hospital and one-month outcomes of primary PCI were analyzed. The patients of the high CysC group were older (mean age 62.8±13.1 vs. 52.3±10.5, P1.12 mg/L) was found to be a powerful independent predictor of one-month cardiovascular mortality (odds ratio, 5.3; 95% confidence interval, 1.25-22.38; P=.02). These results suggest that a high admission CysC level was associated with increased in-hospital and one-month cardiovascular mortality in patients with STEMI undergoing primary PCI. Copyright © 2013 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2013-10-01

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

  7. Predictive Value of Elevated Uric Acid in Turkish Patients Undergoing Primary Angioplasty for ST Elevation Myocardial Infarction.

    Science.gov (United States)

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

    2014-03-01

    Uric acid (UA) is an independent risk factor for the development of coronary heart disease. Serum UA levels have been correlated with all major forms of death from cardiovascular disease, including acute, subacute, and chronic forms of coronary artery disease (CAD), heart failure, and stroke. However, its value in acute ST-segment elevation myocardial infarction (STEMI) remains unclear. The aim of this study was to evaluate the prognostic value of UA in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). We prospectively enrolled 434 consecutive Turkish STEMI patients (mean age 55.4 ± 12.4 years, 341 male, 93 female) undergoing primary PCI. The study population was divided into tertiles based on admission UA values. The high UA group (n = 143) was defined as a value in the third tertile (> 5.7 mg/dl), and the low UA group (n = 291) included those patients with a value in the lower two tertiles (≤ 5.7 mg/dl). Clinical characteristics, in-hospital and six-month outcomes of primary PCI were analyzed. Compared to the low UA group, only Killip class > 1 at admission was more prevalent in the high UA group (3.4% vs. 17.5%, p 5.7 mg/dl) was found to be a powerful independent predictor of six-month all-cause mortality (hazard ratio: 5.57, 95% confidence interval: 1.903-16.3, p = 0.002). These results suggest that a high level of UA on admission was associated with increased in-hospital cardiovascular mortality, and six-month all-cause mortality in Turkish patients with STEMI undergoing primary PCI. Primary angioplasty; ST elevation myocardial infarction; Uric acid.

  8. Contemporary Management of ST-Elevation Myocardial Infarction.

    Science.gov (United States)

    Dind, Ashleigh; Allahwala, Usaid; Asrress, Kaleab N; Jolly, Sanjit S; Bhindi, Ravinay

    2017-02-01

    Recent advances have caused a major shift in the way ST-elevation myocardial infarctions are managed. This review explores the pharmacological and interventional techniques that have evidence for improving outcomes and the landmark trials that have sparked change. The new P2Y 12 inhibitors, ticagrelor and prasugrel, have been shown to be superior to clopidogrel in STEMI patients undergoing primary percutaneous coronary intervention. Concurrently, many technical aspects of percutaneous coronary intervention have been further clarified by trial data, with bare-metal stents, routine thrombus aspiration and femoral access showing evidence of inferiority. Ongoing trials will provide more information on the role of non-culprit lesion PCI, bioresorbable vascular scaffolds, mechanical devices in persistent ischaemia and early automatic implantable cardioverter-defibrillators for inducible ventricular tachycardia. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

  9. 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.

  10. Influence of presenting electrocardiographic findings on the treatment and outcomes of patients with non-ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Patel, Jigar H; Gupta, Raghav; Roe, Matthew T; Peng, S Andrew; Wiviott, Stephen D; Saucedo, Jorge F

    2014-01-15

    The influence of the presenting electrocardiographic (ECG) findings on the treatment and outcomes of patients with non-ST-segment elevation myocardial infarction (NSTEMI) has not been studied in contemporary practice. We analyzed the clinical characteristics, in-hospital management, and in-hospital outcomes of patients with NSTEMI in the Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines (ACTION Registry-GWTG) according to the presenting ECG findings. A total of 175,556 patients from 485 sites from January 2007 to September 2011 were stratified by the ECG findings on presentation: ST depression (n = 40,146, 22.9%), T-wave inversions (n = 24,627, 14%), transient ST-segment elevation (n = 5,050, 2.9%), and no ischemic changes (n = 105,733, 60.2%). Patients presenting with ST-segment depression were the oldest and had the greatest prevalence of major cardiac risk factors. Coronary angiography was performed most frequently in the transient ST-segment elevation group, followed by the T-wave inversion, ST-segment depression, and no ischemic changes groups. The angiogram revealed that patients with ST-segment depression had more left main, proximal left anterior descending, and 3-vessel coronary artery disease and underwent coronary artery bypass grafting most often. In contrast, patients with transient ST-segment elevation had 1-vessel CAD and underwent percutaneous coronary intervention the most. The unadjusted mortality was highest in the ST-segment depression group, followed by the no ischemic changes, transient ST-segment elevation, and T-wave inversion group. Adjusted mortality using the ACTION Registry-GWTG in-hospital mortality model with the no ischemic changes group as the reference showed that in-hospital mortality was similar in the transient ST-segment elevation (odds ratio 1.15, 95% confidence interval 0.97 to 1.37; p = 0.10), higher in the ST-segment depression group (odds ratio 1.46, 95% confidence interval 1

  11. Angiografía del día siguiente tras fibrinólisis exitosa frente al tratamiento convencional, en el síndrome coronario agudo con elevación del segmento ST, fibrinolisado Angiography performed the next day after successful thrombolysis versus conventional treatment in acute coronary syndrome with ST segment elevation

    Directory of Open Access Journals (Sweden)

    José D Cascón-Pérez

    2012-01-01

    Full Text Available Introducción y objetivos: la incorporación de las nuevas guías de actuación de la Sociedad Europea de Cardiología en el síndrome coronario agudo, con coronariografía precoz (24 horas tras trombólisis, incluso si es efectiva y sin necesidad de demostrar signos de isquemia residual, en los casos en los que no se realiza angioplastia primaria, ha supuesto un reto respecto a la forma tradicional de actuar en los Servicios de Cardiología. Métodos: durante 2007, 2008 y la primera mitad de 2009 se atendieron 266 pacientes con infarto agudo del miocardio con ST elevado tratados con trombólisis. De ellos, y tras excluir los rescates (41, en 94 (42% se realizó cateterismo dentro de las primeras 24 horas (angiografía del día siguiente y en los 131 (58% restantes se siguió una estrategia convencional con test de provocación de isquemia (tratamiento convencional. Resultados: en el primer grupo, la estancia media fue de 7,3 ± 3 días [mediana, rango intercuantílico: 7 (5-8]. La incidencia de eventos mortales al año fue de 3 (4%. No hubo ningún sangrado mayor; sólo 20 de ellos (22% presentaron hematomas inguinales mayores de 2 cm. En el segundo, la estancia media fue de 10,2 ± 6,3 días [9 (6-13], significativamente mayor (pIntroduction and objectives: The introduction of new practice guidelines of the European Society of Cardiology in acute coronary syndrome with early coronary angiography (24 hours after thrombolysis, even if it is effective without showing signs of residual ischemia in the cases where primary angioplasty is not performed, has been a challenge over the traditional approach in the Departments of Cardiology. Methods: During 2007, 2008 and the first half of 2009, 266 patients with acute myocardial infarction with ST segment elevation were treated with thrombolysis. After excluding the bailouts (41, in 94 (42% of them, a catheterization was peformed within the first 24 hours (next day angiography and the remaining 131 (58

  12. Primary pci in st elevation myocardial infarction : an experience at afic/nihd rawalpindi

    International Nuclear Information System (INIS)

    Saif, M.; Khan, H.S.; Kha, M.N.; Maken, G.R.

    2013-01-01

    Objective: To evaluate the practicability, safety, and efficacy of primary percutaneous coronary intervention as a therapeutic option in acute ST elevation Myocardial Infarction (STEMI). Study Design: Descriptive study. Place and Duration of Study: The study was carried out in Armed Forces Institute of Cardiology- National Institute of Heart Diseases (AFIC-NIHD) from 18th October 2011 to 30th November 2011. Patients and Methods: All patients presenting with acute STEMI were offered primary PCI. Patients who chose primary PCI as a mode of reperfusion were included in the study. Informed consent was taken and detailed questionnaire was filled for those patients who fulfilled the study criteria. Results: Our initial experience of primary PCI in 33 patients with ST elevation MI has revealed some favourable statistics. Only 01 (3.0%) patient died during hospital stay following the procedure. Thirty two (97%) patients had an uneventful recovery and were successfully discharged 48-72 hours following PCI. Conclusion: We have shown that primary PCI is a viable therapeutic option and can be performed in public sector tertiary care hospitals with excellent immediate, short and long term outcomes despite relatively long symptom onset to emergency room and door-to-balloon times. (author)

  13. Type A Aortic Dissection Presenting with Inferior ST-Elevation Myocardial Infarction.

    Science.gov (United States)

    Wu, Bao-Tzung; Li, Chun-Yi; Chen, Ying-Tsung

    2014-05-01

    Type A aortic dissection with concurrent ST-elevation myocardial infarction (STEMI) is relatively rare. However, it can be potentially fatal and easily misdiagnosed as STEMI alone. Misdiagnosis will lead to inappropriate administration of anticoagulant and thrombolytic therapy and delayed surgical repair of the aorta. In patients with STEMI, short reperfusion time is associated with improved survival, and minimizing the door-to-balloon time is the goal of therapy worldwide. However, signs critical for differential diagnosis may be overlooked in the rush to primary percutaneous coronary intervention. When a patient is encountered who presents with chest pain and ST elevation on electrocardiogram, STEMI should not be the only diagnosis considered. By using bedside available information, detailed history taking and focused physical examination, it is possible to avoid a mistaken diagnosis. Here we report a case of Stanford type A aortic dissection with STEMI that was initially misdiagnosed as sole acute inferior wall myocardial infarction. Patient mortality may have resulted from delayed diagnosis and surgical treatment. Acute myocardial infarction; Aortic dissection.

  14. The Comparison of the Outcomes between Primary PCI, Fibrinolysis, and No Reperfusion in Patients ≥ 75 Years Old with ST-Segment Elevation Myocardial Infarction: Results from the Chinese Acute Myocardial Infarction (CAMI Registry.

    Directory of Open Access Journals (Sweden)

    He Peiyuan

    Full Text Available Only a few randomized trials have analyzed the clinical outcomes of elderly ST-segment elevation myocardial infarction (STEMI patients (≥ 75 years old. Therefore, the best reperfusion strategy has not been well established. An observational study focused on clinical outcomes was performed in this population.Based on the national registry on STEMI patients, the in-hospital outcomes of elderly patients with different reperfusion strategies were compared. The primary endpoint was defined as death. Secondary endpoints included recurrent myocardial infarction, ischemia driven revascularization, myocardial infarction related complications, and major bleeding. Multivariable regression analysis was performed to adjust for the baseline disparities between the groups.Patients who had primary percutaneous coronary intervention (PCI or fibrinolysis were relatively younger. They came to hospital earlier, and had lower risk of death compared with patients who had no reperfusion. The guideline recommended medications were more frequently used in patients with primary PCI during the hospitalization and at discharge. The rates of death were 7.7%, 15.0%, and 19.9% respectively, with primary PCI, fibrinolysis, and no reperfusion (P 0.05. In the multivariable regression analysis, primary PCI outweighs no reperfusion in predicting the in-hospital death in patients ≥ 75 years old. However, fibrinolysis does not.Early reperfusion, especially primary PCI was safe and effective with absolute reduction of mortality compared with no reperfusion. However, certain randomized trials were encouraged to support the conclusion.

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

    Science.gov (United States)

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

    2016-05-01

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

  16. The Comparison of the Outcomes between Primary PCI, Fibrinolysis, and No Reperfusion in Patients ≥ 75 Years Old with ST-Segment Elevation Myocardial Infarction: Results from the Chinese Acute Myocardial Infarction (CAMI) Registry.

    Science.gov (United States)

    Peiyuan, He; Jingang, Yang; Haiyan, Xu; Xiaojin, Gao; Ying, Xian; Yuan, Wu; Wei, Li; Yang, Wang; Xinran, Tang; Ruohua, Yan; Chen, Jin; Lei, Song; Xuan, Zhang; Rui, Fu; Yunqing, Ye; Qiuting, Dong; Hui, Sun; Xinxin, Yan; Runlin, Gao; Yuejin, Yang

    2016-01-01

    Only a few randomized trials have analyzed the clinical outcomes of elderly ST-segment elevation myocardial infarction (STEMI) patients (≥ 75 years old). Therefore, the best reperfusion strategy has not been well established. An observational study focused on clinical outcomes was performed in this population. Based on the national registry on STEMI patients, the in-hospital outcomes of elderly patients with different reperfusion strategies were compared. The primary endpoint was defined as death. Secondary endpoints included recurrent myocardial infarction, ischemia driven revascularization, myocardial infarction related complications, and major bleeding. Multivariable regression analysis was performed to adjust for the baseline disparities between the groups. Patients who had primary percutaneous coronary intervention (PCI) or fibrinolysis were relatively younger. They came to hospital earlier, and had lower risk of death compared with patients who had no reperfusion. The guideline recommended medications were more frequently used in patients with primary PCI during the hospitalization and at discharge. The rates of death were 7.7%, 15.0%, and 19.9% respectively, with primary PCI, fibrinolysis, and no reperfusion (P PCI also had lower rates of heart failure, mechanical complications, and cardiac arrest compared with fibrinolysis and no reperfusion (P PCI, fibrinolysis, and no reperfusion group (P > 0.05). In the multivariable regression analysis, primary PCI outweighs no reperfusion in predicting the in-hospital death in patients ≥ 75 years old. However, fibrinolysis does not. Early reperfusion, especially primary PCI was safe and effective with absolute reduction of mortality compared with no reperfusion. However, certain randomized trials were encouraged to support the conclusion.

  17. 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

  18. 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

    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...... 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...

  19. Effects of age on long-term outcomes after a routine invasive or selective invasive strategy in patients presenting with non-ST segment elevation acute coronary syndromes: a collaborative analysis of individual data from the FRISC II - ICTUS - RITA-3 (FIR) trials.

    Science.gov (United States)

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

    2012-02-01

    To perform a patient-pooled analysis of a routine invasive versus a selective invasive strategy in elderly patients with non-ST segment elevation acute coronary syndrome. A meta-analysis was performed of patient-pooled data from the FRISC II-ICTUS-RITA-3 (FIR) studies. (Un)adjusted HRs were calculated by Cox regression, with adjustments for variables associated with age and outcomes. The main outcome was 5-year cardiovascular death or myocardial infarction (MI) following routine invasive versus selective invasive management. Regarding the 5-year composite of cardiovascular death or MI, the routine invasive strategy was associated with a lower hazard in patients aged 65-74 years (HR 0.72, 95% CI 0.58 to 0.90) and those aged ≥75 years (HR 0.71, 95% CI 0.55 to 0.91), but not in those aged RITA-3).

  20. Sex Differences in Timeliness of Reperfusion in Young Patients With ST-Segment-Elevation Myocardial Infarction by Initial Electrocardiographic Characteristics.

    Science.gov (United States)

    Gupta, Aakriti; Barrabes, Jose A; Strait, Kelly; Bueno, Hector; Porta-Sánchez, Andreu; Acosta-Vélez, J Gabriel; Lidón, Rosa-Maria; Spatz, Erica; Geda, Mary; Dreyer, Rachel P; Lorenze, Nancy; Lichtman, Judith; D'Onofrio, Gail; Krumholz, Harlan M

    2018-03-07

    Young women with ST-segment-elevation myocardial infarction experience reperfusion delays more frequently than men. Our aim was to determine the electrocardiographic correlates of delay in reperfusion in young patients with ST-segment-elevation myocardial infarction. We examined sex differences in initial electrocardiographic characteristics among 1359 patients with ST-segment-elevation myocardial infarction in a prospective, observational, cohort study (2008-2012) of 3501 patients with acute myocardial infarction, 18 to 55 years of age, as part of the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study at 103 US and 24 Spanish hospitals enrolling in a 2:1 ratio for women/men. We created a multivariable logistic regression model to assess the relationship between reperfusion delay (door-to-balloon time >90 or >120 minutes for transfer or door-to-needle time >30 minutes) and electrocardiographic characteristics, adjusting for sex, sociodemographic characteristics, and clinical characteristics at presentation. In our study (834 women and 525 men), women were more likely to exceed reperfusion time guidelines than men (42.4% versus 31.5%; P ST elevation in lateral leads was an inverse predictor of reperfusion delay. Sex disparities in timeliness to reperfusion in young patients with ST-segment-elevation myocardial infarction persisted, despite adjusting for initial electrocardiographic characteristics. Left ventricular hypertrophy by voltage criteria and absence of prehospital ECG are strongly positively correlated and ST elevation in lateral leads is negatively correlated with reperfusion delay. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  1. Optimization of the precordial leads of the 12-lead electrocardiogram may improve detection of ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Scott, Peter J; Navarro, Cesar; Stevenson, Mike; Murphy, John C; Bennett, Johan R; Owens, Colum; Hamilton, Andrew; Manoharan, Ganesh; Adgey, A A Jennifer

    2011-01-01

    For the assessment of patients with chest pain, the 12-lead electrocardiogram (ECG) is the initial investigation. Major management decisions are based on the ECG findings, both for attempted coronary artery revascularization and risk stratification. The aim of this study was to determine if the current 6 precordial leads (V(1)-V(6)) are optimally located for the detection of ST-segment elevation in ST-segment elevation myocardial infarction (STEMI). We analyzed 528 (38% anterior [200], 44% inferior [233], and 18% lateral [95]) patients with STEMI with both a 12-lead ECG and an 80-lead body surface map (BSM) ECG (Prime ECG, Heartscape Technologies, Bangor, Northern Ireland). Body surface map was recorded within 15 minutes of the 12-lead ECG during the acute event and before revascularization. ST-segment elevation of each lead on the BSM was compared with the corresponding 12-lead precordial leads (V(1)-V(6)) for anterior STEMI. In addition, for lateral STEMI, leads I and aVL of the BSM were also compared; and limb leads II, III, aVF of the BSM were compared with inferior unipolar BSM leads for inferior STEMI. Leads with the greatest mean ST-segment elevation were selected, and significance was determined by analysis of variance of the mean ST segment. For anterior STEMI, leads V(1), V(2), 32, 42, 51, and 57 had the greatest mean ST elevation. These leads are located in the same horizontal plane as that of V(1) and V(2). Lead 32 had a significantly greater mean ST elevation than the corresponding precordial lead V(3) (P = .012); and leads 42, 51, and 57 were also significantly greater than corresponding leads V(4), V(5), V(6), respectively (P mean ST-segment elevation; and lead III was significantly superior to the inferior unipolar leads (7, 17, 27, 37, 47, 55, and 61) of the BSM (P optimal placement for the diagnosis of anterior and lateral STEMI and appear superior to leads V(3), V(4), V(5), and V(6). This is of significant clinical interest, not only for ease and

  2. Predictive value of elevated soluble CD40 ligand in patients undergoing primary angioplasty for ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Pusuroglu, Hamdi; Akgul, Ozgur; Erturk, Mehmet; Uyarel, Huseyin; Bulut, Umit; Akkaya, Emre; Buturak, Ali; Surgit, Ozgur; Fuat, Ali; Cetin, Mustafa; Yldrm, Aydn

    2014-11-01

    The aim of this study was to evaluate the prognostic value of soluble CD40 ligand (sCD40L) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing a primary percutaneous coronary intervention (PCI). The prognostic value of sCD40L has been documented in patients with acute coronary syndrome; however, its value in acute STEMI remains unclear. We prospectively enrolled 499 consecutive STEMI patients (397 men, 102 women) undergoing primary PCI. The study population was divided into tertiles on the basis of admission sCD40L values. The high sCD40L group (n=168) included patients with a value in the third tertile (≥0.947 mg/l) and the low sCD40L group (n=331) included patients with a value in the lower two tertiles (0.947 mg/l) is a powerful independent predictor of 1-year all-cause mortality (odds ratio: 3.68; 95% confidence interval: 1.54-8.77; P=0.003). The results of this study suggest that a high sCD40L level at admission is associated with increased in-hospital and 1-year all-cause mortality rates in patients with STEMI undergoing primary PCI.

  3. Primary Percutaneous Coronary Intervention for ST elevation myocardial infarction complicated by Cardiogenic Shock

    International Nuclear Information System (INIS)

    Shaikh, A. H.; Hanif, B.; Pathan, A.; Khan, W.; Hashmani, S.; Raza, M.; Nasir, S.

    2013-01-01

    Objective: To determine the outcomes of primary percutaneous coronary intervention for ST elevation myocardial infarction complicated by cardiogenic shock. Methods: The retrospective study was conducted at the Tabba Heart Institute, a private-sector facility in Karachi. It reviewed the medical records of 56 consecutive patients between January 2009 and June 2011 with acute ST elevation myocardial infarction complicated by cardiogenic shock and subjected to primary percutaneous coronary intervention. The primary end point was in-hospital mortality and its predictors. SPSS 14 was used for statistical analysis. Results: The mean age of the study patients was 63+-11.7 years; 38 (68%) were male; 32 (57%) were hypertensive; and 39 (69%) were diabetic. Most infarcts were anterior in location (n=36; 64%). Besides, 33 (59%) required ventilatory support. Intra-aortic balloon pump was placed in 30 (54%), and 33 (59%) patients had multivessel coronary artery disease. In-hospital mortality occurred in 26 (46%). Multivariate logistic regression analysis showed that age >60 years (p= 0.05), diabetes (p <0.01) and left ventricular ejection fraction <40% (p= 0.01) were independent predictors of in-hospital mortality. Conclusions: Results emphasise the need of aggressive management of patients with cardiogenic shock utilising primary percutaneous coronary intervention as a reperfusion strategy to improve clinical outcomes. (author)

  4. Early Risk stratification for Arrhythmic death in Patients with ST-Elevation Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Sadr-Ameli

    2007-01-01

    Full Text Available Background: Sudden cardiac death is a leading cause of death in patients with ST-elevation myocardial infarction (MI. According to high cost of modern therapeutic modalities it is of paramount importance to define protocols for risk stratification of post-MI patients before considering expensive devices such as implantable cardioverter-defibrillator.Methods: One hundred and thirty seven patients with acute ST-elevation MI were selected and underwent echocardiographic study, holter monitoring and signal-averaged electrocardiography (SAECG. Then, the patients were followed for 12 ±3 months.Results: During follow-up, 13 deaths (9.5% occurred; nine cases happened as sudden cardiac death (6.6%. The effect of ejection fraction (EF less than 40% on occurrence of arrhythmic events was significant (P<0.001. Sensitivity and positive predictive value of EF<40% was 100% and 76.95% respectively. Although with lesser sensitivity and predictive power than EF<40%, abnormal heart rate variability (HRV and SAECG had also significant effects on occurrence of sudden death (P=0.02 and P=0.003 respectively. Nonsustained ventricular tachycardia was not significantly related to risk of sudden death in this study (P=0.20.Conclusions: This study indicated that EF less than 40% is the most powerful predictor of sudden cardiac death in post MI patients. Abnormal HRV and SAECG are also important predictors and can be added to EF for better risk stratification.

  5. 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.

  6. 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

    undergoing angiography with no difference between groups. Bivalirudin was easy to administer in the prehospital setting and did not affect the prehospital run times. In conclusion, the results suggest that prehospital bivalirudin administration is as safe and effective as heparin in the treatment of patients...... 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 with a 1-mg...... 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 percutaneous coronary intervention...

  7. Exercise induced ST elevation and residual myocardial ischemia in previous myocardial infarction

    International Nuclear Information System (INIS)

    Shimonagata, Tsuyoshi; Nishimura, Tsunehiko; Uehara, Toshiisa; Hayashida, Kohei; Saito, Muneyasu; Sumiyoshi, Tetsuya

    1987-01-01

    The purpose of this study was to evaluate the clinical significance of stress induced ST elevation on infarcted area in 65 patients with previous myocardial infarction (single vessel disease) who had stress thallium scan. Stress induced ST changes on infarcted area were compared with quantitative assessment of myocardial ischemia (thallium ischemic score; TIS) and extent of myocardial infarction (defect score; DS) derived from circumferential profile analysis. In patients with previous myocardial infarction in less than 3 month from the onset (n = 36), left ventricular ejection fraction (LVEF) and extent of abnormal LV wall motion were not significantly different between patients with stress induced ST elevation ( ≥ 2 mm, n = 26) and those with stress induced ST elevation ( < 2 mm, n = 10), while, in patients with previous myocardial infarction in more than 3 month (n = 29), patients with stress induced ST elevation ( ≥ 2 mm, n = 15) showed left ventricular dyskinesis more frequently than those with ST elevation ( < 2 mm, n = 14). In addition, the former showed significantly higher DS and significantly lower TIS than the latter. In patients with previous myocardial infarction in less than 3 month, patients with ST elevation ( ≥ 2 mm, n = 15) with prominent upright T wave (n = 15) had transient thallium defect in infarcted area in 73 % and they had significantly higher LVEF and TIS than those with ST elevation ( < 2 mm, n = 11). These results indicated that ST elevation in infarcted area reflect different significance according to the recovery of injured myocardium and stress induced ST elevation with prominent upright T wave in infarcted area reflect residual myocardial ischemia in less than 3 month from the onset of myocardial infarction. (author)

  8. Mechanism of troponin elevations in patients with acute ischemic stroke

    DEFF Research Database (Denmark)

    Jensen, Jesper K.; Atar, Dan; Mickley, Hans

    2007-01-01

    the introduction of troponin in the diagnosis of acute myocardial infarction, this marker has been measured in a number of other conditions as well. One of these conditions is acute ischemic stroke, causing diagnostic dilemmas for clinicians. Because various electrocardiographic alterations have also been reported...... in these patients, it has been suggested that elevated troponin levels are somehow neurologically mediated, thus not caused by direct cardiac release. In conclusion, this review examines the available studies that systematically measured troponin in patients with acute ischemic stroke to properly interpret troponin...... elevations in these patients Udgivelsesdato: 2007-Mar-15...

  9. 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)....

  10. Inhibition of delta-protein kinase C by delcasertib as an adjunct to primary percutaneous coronary intervention for acute anterior ST-segment elevation myocardial infarction: results of the PROTECTION AMI Randomized Controlled Trial

    NARCIS (Netherlands)

    Lincoff, A.M.; Roe, M.; Aylward, P.; Galla, J.; Rynkiewicz, A.; Guetta, V.; Zelizko, M.; Kleiman, N.; White, H.; McErlean, E.; Erlinge, D.; Laine, M.; Ferreira, J.M. Dos Santos; Goodman, S.; Mehta, S.; Atar, D.; Suryapranata, H.; Jensen, S.E.; Forster, T.; Fernandez-Ortiz, A.; Schoors, D.; Radke, P.; Belli, G.; Brennan, D.; Bell, G.; Krucoff, M.; et al.,

    2014-01-01

    AIMS: Delcasertib is a selective inhibitor of delta-protein kinase C (delta-PKC), which reduced infarct size during ischaemia/reperfusion in animal models and diminished myocardial necrosis and improved reperfusion in a pilot study during primary percutaneous coronary intervention (PCI) for ST

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

    Science.gov (United States)

    Lewicki, Lukasz; Siebert, Janusz; Marek-Trzonkowska, Natalia; Masiewicz, Emilia; Kolinski, Tomasz; Reiwer-Gostomska, Magdalena; Targonski, Radoslaw; Trzonkowski, Piotr

    2015-01-01

    An inflammatory response plays a crucial role in myocardial damage after an acute myocardial infarction. 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. 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. 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. Elevated serum tryptase and ET-1 may be markers of increased coronary instability; some cytokines may be related to the extension of CAD.

  12. Elevated plasma procalcitonin level predicts poor prognosis of ST elevation myocardial infarction in Asian elderly.

    Science.gov (United States)

    Dai, Junru; Xia, Bangbo; Wu, Xiaomiao

    Previous studies have focused on relationship between plasma procalcitonin level and myocardial infarction risk, but this relationship in Asian elderly has not been investigated. The aim of this study was to reveal the association of peripheral procalcitonin concentration (both immediate and average levels) with myocardial infarction prognosis in Asian elderly. A total of 400 ST-elevation myocardial infarction patients, 400 unstable angina patients and 400 controls were included. Plasma levels of high-sensitivity C-reactive protein and procalcitonin were measured using commercially available kits. Each myocardial infarction patient received a standard therapy and a 12-month follow-up unless major adverse cardiac events occurred. On admission, plasma procalcitonin level was higher in myocardial infarction patients than in unstable angina patients and controls (p < .001). In the follow-up period, 142 myocardial infarction patients suffered from major adverse cardiac events, and other 258 myocardial infarction patients did not. Higher admission, peak and average plasma levels of procalcitonin in the first week after chest pain onset were associated with elevated risk of major adverse cardiac events (HR: 1.46, 95%CI: 1.18-1.99; HR: 2.57, 95%CI: 1.99-3.52; HR: 2.36, 95%CI: 1.81-3.00). Plasma procalcitonin level had a positive linear correlation with plasma level of high-sensitivity C-reactive protein on admission (r = 0.650, p < .001). In conclusion, peripheral concentration of procalcitonin (both immediate and average levels) might be an independent predictor for prognosis in myocardial infarction patients. Prognostic significance of procalcitonin might be implicated in inflammation.

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

    Science.gov (United States)

    Yılmaz, Mücahid; Korkmaz, Hasan

    2018-04-01

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

  14. Effects of Prolastin C (Plasma-Derived Alpha-1 Antitrypsin) on the acute inflammatory response in patients with ST-segment elevation myocardial infarction (from the VCU-alpha 1-RT pilot study)

    NARCIS (Netherlands)

    Abbate, A.; Tassell, B.W. Van; Christopher, S.; Abouzaki, N.A.; Sonnino, C.; Oddi, C.; Carbone, S.; Melchior, R.D.; Gambill, M.L.; Roberts, C.S.; Kontos, M.C.; Peberdy, M.A.; Toldo, S.; Vetrovec, G.W.; Biondi-Zoccai, G.; Dinarello, C.A.

    2015-01-01

    Alpha-1 antitrypsin (AAT) has broad anti-inflammatory and immunomodulating properties in addition to inhibiting serine proteases. Administration of human plasma-derived AAT is protective in models of acute myocardial infarction in mice. The objective of this study was to determine the safety and

  15. 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; Melle, van J.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

  16. ST Elevation in Lead aVR and Its Association with Clinical Outcomes

    Directory of Open Access Journals (Sweden)

    Eka Ginanjar

    2018-01-01

    Full Text Available The purpose of this case repots are to evaluate the role of ST elevation in aVR lead and to make analysis between both cases. There are some atypical electrocardiogram (ECG presentations which need prompt management in patient with ischemic clinical manifestation such as ST elevation in aVR lead. In this case study, we report a 68-year old woman with chief symptoms of shortness of breath and chest discomfort. She was diagnosed with cardiogenic shock, with Killip class IV, and TIMI score of 8. The second case is a 57-year-old man with typical chest pain at rest which could not be relieved with nitrate treatment. He was diagnosed with ST elevation in inferior and aVR lead, and occlusion in left circumflex artery (LCX. Both patients underwent primary percutaneous coronary intervention (PPCI. Subsequently, both cases presented remarkable clinical improvements and improved ST elevation myocardial infarction (STEMI in aVR lead.

  17. 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...

  18. ST elevation after intracoronary administration of Papaverine for fractional flow reserve estimation

    Directory of Open Access Journals (Sweden)

    R.K. Jain

    2014-05-01

    Conclusion: Transient ST elevation occurs in a significant proportion of cases receiving IC papaverine which is not associated with any adverse clinical outcomes. Micro vascular dysfunction is the most likely mechanism of this phenomenon.

  19. Early invasive vs conservative treatment strategies in women and men with unstable angina and non-ST-segment elevation myocardial infarction: a meta-analysis

    NARCIS (Netherlands)

    O'Donoghue, Michelle; Boden, William E.; Braunwald, Eugene; Cannon, Christopher P.; Clayton, Tim C.; de Winter, Robbert J.; Fox, Keith A. A.; Lagerqvist, Bo; McCullough, Peter A.; Murphy, Sabina A.; Spacek, Rudolf; Swahn, Eva; Wallentin, Lars; Windhausen, Fons; Sabatine, Marc S.

    2008-01-01

    CONTEXT: Although an invasive strategy is frequently used in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS), data from some trials suggest that this strategy may not benefit women. OBJECTIVE: To conduct a meta-analysis of randomized trials to compare the effects of an

  20. Baseline Q waves as a prognostic modulator in patients with ST-segment elevation: insights from the PLATO trial.

    Science.gov (United States)

    Siha, Hany; Das, Debraj; Fu, Yuling; Zheng, Yinggan; Westerhout, Cynthia M; Storey, Robert F; James, Stefan; Wallentin, Lars; Armstrong, Paul W

    2012-07-10

    Baseline Q waves may provide additional value compared with time from the onset of symptoms in predicting outcomes for patients with ST-segment elevation. We evaluated whether baseline Q waves superseded time from symptom onset as a prognostic marker of one-year mortality in patients with ST-segment elevation acute coronary syndrome. Our study was derived from data from patients undergoing primary percutaneous coronary intervention within 24 hours in the PLATelet inhibition and patient Outcomes trial Q waves on the baseline electrocardiogram were evaluated by a blinded core laboratory. We assessed the associations between baseline Q waves and time from symptom onset to percutaneous coronary intervention with peak biomarkers, ST-segment resolution on the discharge electrocardiogram, and one-year all-cause and vascular mortality. Of 4341 patients with ST-segment elevation, 46% had baseline Q waves. Compared to those without Q waves, those with baseline Q waves were older, more frequently male, had higher heart rates, more advanced Killip class and had a longer time between the onset of symptoms and percutaneous coronary intervention. They also had higher one-year all-cause mortality than patients without baseline Q waves (baseline Q waves: 4.9%; no baseline Q waves: 2.8%; hazard ratio [HR] 1.78, 95% confidence interval [CI] 1.29-2.45, p waves. After multivariable adjustment, baseline Q waves, but not time from symptom onset, were associated with a significant increase in all-cause mortality (adjusted HR 1.42, 95% CI 1.10-2.01, p = 0.046) and vascular mortality (adjusted HR 1.58, 95% CI 1.09-2.28, p = 0.02). The presence of baseline Q waves provides useful additional prognostic insight into the clinical outcome of patients with ST-segment elevation. Clinical Trials.gov registration no. NCT00391872.

  1. 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, RS; Jorgensen, E; Wang, Y

    2006-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Jamil da Silva Soares

    2009-06-01

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

  3. Early 21st century spatially detailed elevation changes of Jammu and Kashmir glaciers (Karakoram–Himalaya)

    DEFF Research Database (Denmark)

    Vijay, Saurabh; Braun, Matthias

    2018-01-01

    Although a number of studies indicate the regional heterogeneity of the glacier elevation and mass changes in high-mountain Asia in the early 21st century, little is known about these changes with high spatial detail for some of the regions. In this study we present respective glacier elevation a...

  4. 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 patients with ST-elevation myocardial infarction (STEMI) the amount of myocardial area at risk (MaR) indicates the maximal potential loss of myocardium if the coronary artery remains occluded. During the time course of infarct evolution ischemic MaR is replaced by necrosis, which results...... 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...... reperfusion (ECG2). The combined Aldrich and Selvester score was considered stable if the difference between ECG1 and ECG2 was ST elevation in 4...

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

    DEFF Research Database (Denmark)

    Kelbæk, Henning; Høfsten, Dan Eik; Køber, Lars

    2016-01-01

    to assess the clinical outcomes of deferred stent implantation versus standard PCI in patients with STEMI. METHODS: We did this open-label, randomised controlled trial at four primary PCI centres in Denmark. Eligible patients (aged >18 years) had acute onset symptoms lasting 12 h or less, and ST......-segment elevation of 0·1 mV or more in at least two or more contiguous electrocardiographic leads or newly developed left bundle branch block. Patients were randomly assigned (1:1), via an electronic web-based system with permuted block sizes of two to six, to receive either standard primary PCI with immediate...

  6. Elevated T-wave alternans predicts nonsustained ventricular tachycardia in association with percutaneous coronary intervention in ST-segment elevation myocardial infarction (STEMI) patients.

    Science.gov (United States)

    Verrier, Richard L; Nearing, Bruce D; Ghanem, Raja N; Olson, Rachel E; Garberich, Ross F; Katsiyiannis, William T; Gornick, Charles C; Tang, Chuen Y; Henry, Timothy D

    2013-06-01

    Successful reperfusion with primary percutaneous coronary intervention (PCI) can paradoxically elicit temporary vulnerability to ventricular arrhythmia. We examined whether T-wave alternans (TWA) level is correlated with nonsustained ventricular tachycardia (NSVT) incidence in association with PCI in patients with acute ST-segment elevation myocardial infarction (STEMI). We analyzed continuous 24-hour ambulatory electrocardiograms in 48 STEMI patients during and after successful primary PCI, achieving Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow. TWA was measured using modified moving average method. Maximum TWA was elevated in patients with (N = 22) compared to without (N = 26) NSVT (75.1 ± 6.3 vs 49.9 ± 3.6 μV, P < 0.005) during the 22-hour monitoring period. TWA ≥ 60μV predicted NSVT with sensitivity of 77%; specificity, 73%; positive predictive value, 71%; and negative predictive value, 79%. Area under receiver operator characteristic curve (AUC) was 0.87 for maximum TWA in predicting NSVT. By comparison, ST-segment levels did not differ in patients with versus without NSVT and were not predictive (AUC = 0.52). TWA was elevated prior to PCI and remained elevated at 30 minutes after balloon inflation despite restoration of TIMI grade 3 flow in all patients, declining by 22 hours (P < 0.05). Maximum ST-segment levels decreased from before PCI to 30 minutes after balloon inflation. TWA is regionally specific, with higher values prior to PCI in precordial lead V5 than in V1 for left coronary lesions. TWA may be useful in identifying individuals at heightened risk for arrhythmia in association with primary PCI and can potentially signal time-dependent changes in arrhythmia vulnerability. © 2013 Wiley Periodicals, Inc.

  7. Elevated serum osteoprotegerin levels predict in-hospital major adverse cardiac events in patients with ST elevation myocardial infarction.

    Science.gov (United States)

    Çanga, Aytun; Durakoğlugil, Murtaza Emre; Erdoğan, Turan; Kirbaş, Aynur; Yilmaz, Adnan; Çiçek, Yüksel; Ergül, Elif; Çetin, Mustafa; Kocaman, Sinan Altan

    2012-11-01

    The aim of our study was to investigate whether osteoprotegerin (OPG) is related to in-hospital major adverse cardiac events (MACE) and reperfusion parameters in patients with ST elevation myocardial infarction (STEMI). The OPG/receptor activator of nuclear factor-κB (RANK)/RANK ligand pathway has recently been associated with atherosclerosis. OPG is a predictor of cardiovascular events in patients with acute coronary syndrome. This study included 96 consecutive patients with STEMI undergoing primary percutaneous coronary intervention (PCI). Two groups with equal number of patients were formed according to median OPG level. The association of OPG levels on admission with post-procedural reperfusion parameters, and in-hospital MACE were investigated. Patients with higher OPG levels displayed higher neutrophil/lymphocyte ratio, admission troponin, admission glucose, and high-sensitive C-reactive protein. Higher OPG levels were associated with increased thrombolysis in myocardial infarction (TIMI) risk score, TIMI risk index, pain to balloon time, need for inotropic support, shock, and MACE, mainly driven by death. Reperfusion parameters were not different between the two groups. TIMI risk score, TIMI risk index, myocardial blush grade, estimated glomerular filtration rate (eGFR), number of obstructed vessels, and OPG significantly predicted adverse cardiac events. Multiple logistic regression analysis revealed OPG as an independent predictor of MACE as well as eGFR, number of obstructed vessels, and corrected TIMI frame count. OPG, a bidirectional molecule displaying both atheroprotective and pro-atherosclerotic properties, is currently known as a marker of inflammation and a predictor of cardiovascular mortality. The present study, for the first time, demonstrated that an increased OPG level is related to in-hospital adverse cardiovascular events after primary PCI in patients with STEMI. Copyright © 2012 Japanese College of Cardiology. Published by Elsevier Ltd

  8. 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

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

    International Nuclear Information System (INIS)

    Croft, C.H.; Woodward, W.; Nicod, P.; Corbett, J.R.; Lewis, S.E.; Willerson, J.T.; Rude, R.E.

    1982-01-01

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

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

    International Nuclear Information System (INIS)

    Chalela, William Azem; Soares, J. Jr.; Meneghetti, J.C.; Olivera, C.G.; Moffa, P.J.; Falcao, A.M.; Ramires, J.A.F.

    2004-01-01

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

  11. ST-segment elevation and ventricular fibrillation shortly after transseptal puncture for left atrial catheter ablation

    Directory of Open Access Journals (Sweden)

    Daisuke Ishigaki, MD

    2013-10-01

    Full Text Available A 47-year-old man with drug-resistant paroxysmal atrial fibrillation underwent left atrial (LA catheter ablation. After sheaths were inserted into the LA using the Brockenbrough method, he complained of angina and developed ST-segment elevation in the II, III, aVF, V5, and V6 leads. Ventricular fibrillation (VF occurred followed by ventricular tachycardia. The VF was successfully treated with direct current shock. Coronary angiography with isosorbide dinitrate showed neither spasm nor embolism in the coronary artery. The chest pain disappeared after 6 min with resolution of the ST-segment elevation. A summarized review of ST-segment elevation associated with transseptal puncture disclosed that ST-segment elevation is often found in inferior leads (87.5%, while concomitant bradyarrhythmia has been reported in 43.8% of patients. Our patient is the first recorded case with potentially lethal tachyarrhythmia. Although ST-segment elevation and VF is a rare complication associated with transseptal puncture, awareness of this complication is important.

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

    International Nuclear Information System (INIS)

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

    2016-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Hansen, Morten Steen Svarer, E-mail: morten.steen.hansen2@rsyd.dk [Emergency Department, Kolding Hospital, Skovvangen 2-8, DK-6000 Kolding (Denmark); Antonsen, Lisbeth; Jensen, Lisette Okkels [Department of Cardiology, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense (Denmark)

    2016-04-15

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

  14. Elevated Hemi-diaphragms as a Cause of ST-segment Elevation: A case report and review of literature.

    Science.gov (United States)

    Singh, Manmohan; Sood, Aditya; Rehman, Mobeen Ur; Othman, Mahmoud; Afonso, Luis

    While ST-segment elevation (STE) on ECG is widely recognized as representing myocardial infarction or injury such as coronary occlusion or pericarditis, STE may occasionally ensue from non-cardiac etiologies. Indeed, gastrointestinal disorders causing STE are not well documented in the literature. We present a case wherein extreme abdominal distension and hemi-diaphragm elevation resulted in extrinsic cardiac and epicardial coronary compression manifesting as STE. Subsequent relief of the abdominal distension resulted in resolution of STE representing a noncoronary cause of STE. A brief literature review, illustrating the importance of considering abdominal etiologies as a cause of STE is provided. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. The electrocardiographic "triangular QRS-ST-T waveform" pattern in patients with ST-segment elevation myocardial infarction: Incidence, pathophysiology and clinical implications.

    Science.gov (United States)

    Cipriani, Alberto; D'Amico, Gianpiero; Brunello, Giulia; Perazzolo Marra, Martina; Migliore, Federico; Cacciavillani, Luisa; Tarantini, Giuseppe; Bauce, Barbara; Iliceto, Sabino; Corrado, Domenico; Zorzi, Alessandro

    A specific ECG pattern of presentation of ST-segment elevation acute myocardial infarction (STEMI), characterized by "triangular QRS-ST-T waveform" (TW), has been associated with poor in-hospital prognosis but longitudinal data on its incidence and clinical impact are lacking. We prospectively evaluated the incidence and prognostic meaning of the TW pattern in a cohort of consecutive STEMI patients. All STEMI patients who presented within 12h of symptoms onset and showed no complete bundle branch block or paced ventricular rhythm were included. The TW pattern was defined as a unique, giant wave (amplitude≥1mV) resulting from the fusion of the QRS complex, the ST-segment and the T-wave and showing a "triangular" morphology with a positive polarity in the leads exploring the ischemic region. Among 428 consecutive STEMI patients, 367 fulfilled the enrollment criteria. The TW pattern was identified in 5 of 367 patients (1.4%) on the admission ECG. This subset of STEMI patients with TW pattern significantly more often showed a left main coronary artery involvement (2/4, 50% vs 2/322, 0.6%; p<0.001), experienced ventricular fibrillation (5/5, 100% vs 35/362, 9.6% p<0.001), had cardiogenic shock (4/5, 80% vs. 14/362, 3.8%, p<0.001) and died during hospitalization (2/5, 40% vs 15/362, 4.1% p=0.02), compared with those with other ST-segment elevation ECG patterns. The TW pattern is an uncommon ECG finding, which reflects the presence of a large area of transmural myocardial ischemia and predicts cardiogenic shock accounting for high in-hospital mortality. When present, this ECG pattern should prompt aggressive therapeutic strategies, including mechanical support of circulation. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Gender disparity in emergency department non-ST elevation myocardial infarction management.

    Science.gov (United States)

    Greenberg, Marna Rayl; Bond, William F; MacKenzie, Richard S; Lloyd, Rezarta; Bindra, Monisha; Rupp, Valerie A; Crown, Anne-Marie; Reed, James F

    2012-05-01

    Many studies have looked at differences between men and women with acute coronary syndrome. These studies demonstrate that women have worse outcomes, receive fewer invasive interventions, and experience delay in the initiation of established medical therapies. Using innovative technology, we set out to unveil and resolve any gender disparities in the evaluation and treatment of patients presenting with a positive troponin while in the emergency department. Our goal was to assess the feasibility of using a business management query system to create an automated data report that could identify deficiencies in standards of care and be used to improve the quality of treatment we provide our patients. Over a 12-month period, key markers for patients with non-ST elevation myocardial infarction (NSTEMI) were tracked (e.g., time to electrocardiogram, door to medications). During this time, educational endeavors were initiated utilizing McKesson's Horizon Business Insight™ (McKesson Information Solutions, Alpharetta, GA) to illustrate gender differences in standard therapy. Subsequently, indicators were evaluated for improvement. Substantial improvements in key indicators for management of NSTEMI were obtained and gender differences minimized where education was provided. The integration of these information systems allowed us to create a successful performance improvement tool and, as an added benefit, nearly eliminated the need for manual retrospective chart reviews. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. Disparities in Revascularization After ST Elevation Myocardial Infarction (STEMI) Before and After the 2002 IOM Report.

    Science.gov (United States)

    Bolorunduro, Oluwaseyi B; Kiladejo, Adekunle V; Animashaun, Islamiyat Babs; Akinboboye, Olakunle O

    2016-05-01

    To examine nationwide trends for racial disparities in Percutaneous Coronary Intervention after ST elevated Myocardial Infarction (STEMI). The Institute of Medicine (IOM) report published in 2002 showed that African Americans were less likely to receive coronary revascularization such as CABG and stents even after controlling for socioeconomics. It recommended increased awareness of these disparities among health professionals to reduce this. We hypothesized that increased awareness of disparities since this report would have translated to reduction in racial disparities in percutaneous coronary intervention. A retrospective analysis was conducted using data from the Agency of Healthcare Research and Quality's (AHRQ) National Inpatient Sample (NIS) 1998-2007. All patients with STEMI during this period were identified. The proportion that received Percutaneous Coronary Intervention (PCI) during the incident admission was compared by different ethnicities over the time period. Multivariable regression for each year was conducted using Poisson regression with robust variances. The analysis controlled for gender, insurance status, co-morbidities, hospital bed size, location and teaching status. Based on the database, about 2.04 million patients were managed for acute Myocardial Infarction from 1998 to 2007, of these 938,176 had STEMI. The primary PCI rate after STEMI among Caucasians was 29.1%, African Americans-23.3% and Hispanics-28.3% [P IOM report. Copyright © 2016 National Medical Association. Published by Elsevier Inc. All rights reserved.

  18. Prognostic implications of fluid balance in ST elevation myocardial infarction complicated by cardiogenic shock.

    Science.gov (United States)

    Arbel, Yaron; Mass, Ronen; Ziv-Baran, Tomer; Khoury, Shafik; Margolis, Gilad; Sadeh, Ben; Flint, Nir; Ben-Shoshan, Jeremy; Finn, Talya; Keren, Gad; Shacham, Yacov

    2017-08-01

    Positive fluid balance has been associated with adverse outcomes in patients admitted to general intensive care units. We analysed the relationship between a positive fluid balance and its persistence over time in terms of in-hospital outcomes among ST elevation myocardial infarction (STEMI) patients complicated by cardiogenic shock. We retrospectively studied fluid intake and output for 96 hours following hospital admission in 48 consecutive adult patients with STEMI complicated by cardiogenic shock, all undergoing primary angioplasty. Daily and accumulated fluid balance was registered at up to 96 hours following admission. The cohort was stratified into two groups based on the presence or absence of positive fluid balance on day 4. Patients' records were assessed for in-hospital adverse outcomes, as well as 30-day all-cause mortality. A positive fluid balance was present in 19/48 patients (40%). Patients with positive fluid balance were older and more likely to be treated by intra-aortic balloon counter-pulsation and antibiotics. These patients were more likely to develop acute kidney injury and to need new intubation and were less likely to have renal function recovery as well as successful weaning from mechanical ventilation ( p balance had higher 30-day mortality (68% vs. 10%; p balance, the adjusted risk for 30-day mortality increased by 24% (hazard ratio: 1.24, 95% confidence interval: 1.07-1.42; p = 0.003). A positive fluid balance was strongly associated with higher 30-day mortality in STEMI complicated by cardiogenic shock.

  19. Reciprocal ST-Segment Changes in Myocardial Infarction: Ischemia at Distance Versus Mirror Reflection of ST-Elevation.

    Science.gov (United States)

    Vaidya, Gaurang Nandkishor; Antoine, Steve; Imam, Syed Haider; Kozman, Hani; Smulyan, Harold; Villarreal, Daniel

    2018-02-01

    Reciprocal ST-depression in the electrocardiograms (ECGs) of patients with ST-elevation myocardial infarction (STEMI) results from either true ischemia at a distance via collateral circulation diverting blood to the infarcted region or an electrical phenomenon that results from a mirror reflection of ST-elevation. We aimed to identify the role of reciprocal ECG changes in predicting collateral circulation to the infarcted area determined angiographically. In a retrospective study, ECG and angiography of 53 STEMI patients admitted to SUNY Upstate Medical University in 2014 were reviewed independently by experts blinded to the results of ECG and coronary angiography. Reciprocal changes (RC) in ECG were present in 41 patients (77%) and on angiography, 14 patients (26%) exhibited collateral vessels to the ischemic areas. No correlation was found between the presence of RC and collateral circulation (P = 0.384), or between the depth of reciprocal ST-depression and the degree of the collateral circulation (P = 0.195). However, 84% of patients without collaterals exhibited resolution of RC after successful percutaneous coronary intervention (PCI) (P = 0.036), suggesting that the ST depressions that resolved after reperfusion were directly caused by the culprit vessel. Patients without RC presented late after symptom onset (9.25 versus 3.83 hours, P = 0.004), also suggesting time related resolution. RC had no relation to or predictive value for collaterals on angiography. Among late presenting patients, RC were less frequent. Thus, reciprocal ST-depression may represent subendocardial ischemia from the primary coronary event or simply an electrical phenomenon, rather than ischemia at distance from impaired collateral circulation. Published by Elsevier Inc.

  20. 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.

  1. A Left Main Coronary Artery Thrombus Presenting as a Non St Elevation MI.

    Science.gov (United States)

    Ezema, U; Daberkow, D; Delord, T; Guidry, L; Sells, N R

    2017-01-01

    Left main coronary artery (LMCA); thrombus with an acute myocardial infarction identified with coronary angiography is a clinically rare condition with an extremely high mortality rate. We present a case of LMCA thrombus that presented as a non-ST elevation myocardial infarction (NSTEMI);. A 45-year-old woman with a history of tobacco use and hyperlipidemia presented with a complaint of 10/10 "hard pain" across her chest radiating to her left shoulder and breast which woke her from sleep. The pain was constant and severe, with no alleviation with rest. She had not experienced anything like this before. Workup revealed an upward trending troponin (1.98.989.79);, and an EKG with some tachycardia but no ST elevation or T wave changes. Her CBC, CMP and coagulation studies were unremarkable. A toxicology screen was positive for opiates and benzodiazepines, medications she was on for pain and anxiety respectively. ACS protocol was started with DAPT, LMWH, Statin, ACEi, and Beta-blocker. An angiogram revealed a large thrombus in the LM coronary artery extending into the aorta with concomitant 99 percent stenosis of distal LAD. 2D Echo w/ bubble contrast was significant for PFO, akinetic apical inferior and anterior wall. The mid antero-septum and apical lateral wall were hypokinetic. Interventional Cardiology and CTS recommended conservative management with medical optimization (Continue DAPT, heparin);, watchful waiting for the thrombus to resorb. Left main coronary artery thrombosis (LMCAT); identified during coronary angiography is a rare and challenging condition. It is a life threatening condition with an approximate incidence rate of 0.8 percent . It is thought to be secondary to plaque rupture with subsequent thrombus formation that is associated with persistent hypercoagulable state, cocaine induced plaque rupture or coronary vasospasm, post-partum state and embolization of intra-cardiac masses. The patient presentation can vary from sudden cardiac death to

  2. Markers of Autolysis in Acute ST Elevation Myocardial Infarction.

    Science.gov (United States)

    Maharjan, P; Manandhar, R; Xu, W; Ma, S; Han, W; Liu, Y; Zhou, Y; Rijal, Y; Sun, C; Yuan, Z

    2015-01-01

    The availability of reliable noninvasive markers for infarct-related artery (IRA) patency status are very limited, otherwise could allow early identification of patients with patent IRA, for whom repeat thrombolysis or rescue percutaneous coronary intervention (PCI) are not necessary. We conducted a single centered retrospective study of STEMI patients undergoing primary PCI to determine how various factors such as demographic characteristics, risk markers of coronary heart disease, clinical and blood parameters present differently in patients with higher coronary flow and patent infarct related artery from patients with total occlusion at the time of initial angiography and how they affect in outcome of the disease. MPV level (11.96 fL vs. 10.92 fL, P < 0.001), Lp (a) level (179.57 nmol/l vs 141.16 nmol/l , p < 0.001), CK-MB (290.2 vs. 190.98, P < 0.001), total cholesterol level (4.11 mmol/L vs. 3.8 mmol/L, p < 0.02) in total occlusion group were higher than in the patent IRA group. Wall motion abnormality was 77.2% for 203 patients with total occlusion group and 54.2% for 83 patients with patent IRA group (P<0.01). Mean hospital stay days were higher in total occlusion group as compared to the patent IRA group P < 0.01. MVP, Lp (a), TC, and CK-MB levels and myocardial wall motion at the presentation may play the role of markers for IRA patency status that will help in early identification of patients with IRA, for whom repeat thrombolysis or rescue PCI may not be required.

  3. 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...

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

    Science.gov (United States)

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

    2017-11-01

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

  5. 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

    BACKGROUND: The 2013 American College of Cardiology Foundation/American Heart Association guidelines for patients with ST-segment-elevation myocardial infarction gives a class III indication for nonculprit artery percutaneous coronary intervention at the time of primary percutaneous coronary inte...

  6. Brugada-like Precordial ST Elevation on ECG by Anterior Mediastinal Infective Mass Lesion

    Directory of Open Access Journals (Sweden)

    Yuji Nakazato

    2003-07-01

    Full Text Available Several causes are known to induce the right precordial ST elevation mimicking Brugada syndrome. Right ventricular outflow area is assumed to be responsible for such ECG changes. We experienced a case of anterior mediastinal infective mass lesion with a Brugada-like ECG. A 52-year-old female, who has pulmonary stenosis and recurrent episodes of right ventricular heart failure, complained of high fever, abdominal discomfort, and edema. On physical examination, jugular vein dilation, hepatomegaly, and facial and leg edema were noted. Leucocytosis was also noted on blood examination. An ECG showed right ventricular hypertrophy, incomplete right bundle branch block pattern and marked ST elevation on precordial leads mimicking Brugada syndrome. Magnetic resonance imaging revealed an abnormal mass shadow located on the anterior mediastinum and compressing the right ventricle (Figure 1A. Trans-thoracic echocardiography also showed the high echogenic mass lesion at the anterior side of right ventricle and the vicinity of pulmonary valve. After treatment with antibiotics, the mass lesion gradually shrunk. Concomitantly, the ST elevation disappeared with improvement of inflammatory markers (Figure 1B. The symptoms suggesting right ventricular failure were also ameliorated. The mechanism of Brugada-like ST elevation in this patient was considered to be compression, by the abnormal infective mass, of the right ventricular outflow tract with/without focal pericardial inflammation.

  7. Risk factors of late cardiogenic shock and mortality in ST-segment elevation myocardial infarction patients

    DEFF Research Database (Denmark)

    Obling, Laust; Frydland, Martin; Hansen, Rikke

    2018-01-01

    BACKGROUND: The incidence of cardiogenic shock (CS) in patients with ST-segment elevation myocardial infarction (STEMI) is as high as 10%. The majority of patients are thought to develop CS after admission (late CS), but the incidence in a contemporary STEMI cohort admitted for primary percutaneo...

  8. 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...

  9. Complete versus culprit-only revascularisation in ST elevation myocardial infarction with multi-vessel disease

    DEFF Research Database (Denmark)

    Bravo, Claudio A.; Hirji, Sameer A.; Bhatt, Deepak L.

    2017-01-01

    Background: Multi-vessel coronary disease in people with ST elevation myocardial infarction (STEMI) is common and is associated with worse prognosis after STEMI. Based on limited evidence, international guidelines recommend intervention on only the culprit vessel during STEMI. This, in turn, leaves...

  10. Coronary Catheterization Laboratory Role for Post-Resuscitation Care Without ST Elevation Myocardial Infarction.

    Science.gov (United States)

    Kumar, Kris; Lotun, Kapildeo

    2018-05-07

    Out of hospital cardiac arrest management of patients with non-ST myocardial infarction per current American Heart Association and European Resuscitation Council guidelines leave the decision in regard to early angiography up to the physician operators. Guidelines are clear on the positive impact of early intervention on survival and improvement on left ventricular function in patients presenting with cardiac arrest and ST elevation myocardial infarction on electrocardiogram. This review aims to analyze the data that current guidelines are based upon in regards to out of hospital cardiac arrest with electrocardiogram findings of non-ST elevation myocardial infarction as well as other clinical trials that support early angiography and reperfusion strategies as well as future studies that are in trial to study the role of the coronary catheterization laboratory in cardiac arrest. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  11. Elevated admission microalbuminuria predicts poor myocardial blood flow and 6-month mortality in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.

    Science.gov (United States)

    Chen, Jia Wei; Wang, Yong Liang; Li, Hong Wei

    2012-04-01

    Microalbuminuria (MA) is considered a major risk factor predisposing to cardiovascular morbidity and mortality. Outcomes after percutaneous coronary intervention (PCI) for patients with acute myocardial infarction (AMI) complicated by MA have been well described. However, data regarding admission MA and coronary and myocardial flow are scant. The aims of this study were to evaluate the effects of admission MA on coronary blood flow and prognosis in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary PCI. Did elevated admission microalbuminuria predict poor myocardial blood flow and 6-month mortality in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention? A total of 247 patients undergoing primary PCI for STEMI within 12 hours after symptom onset were studied. Patients were divided into 2 groups according to admission urinary albumin extraction rate (UAER): (1) an MA group (UAER 20-200 µg/min), and (2) a normoalbuminuria (NA) group (UAER < 20 µg/min). Microalbuminuria was observed in 108 patients. Univariate analyses showed statistical differences between the NA and MA groups in serum creatine level, plasma glucose level, and peak creatine kinase level on presentation. Thrombolysis In Myocardial Infarction (TIMI) flow grades (TFGs) 0-2 in the MA group were more frequent (9.4% vs 21.2%, P < 0.05) than in the NA group, and corrected TIMI frame count was higher (23.9 ± 18.5 vs 29.8 ± 23.5, P < 0.05). Admission MA was an independent predictor of poor myocardial perfusion (adjusted relative risk: 3.14, 95% confidence interval: 0.99-6.78) and a higher rate of 6-month mortality in STEMI patients undergoing primary PCI (adjusted relative risk: 1.58, 95% confidence interval: 0.74-3.39). Admission MA levels are associated with impaired myocardial flow and poor prognosis in STEMI patients undergoing primary PCI. © 2012 Wiley Periodicals, Inc.

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

    International Nuclear Information System (INIS)

    Baker, Nevin C.; Escarcega, Ricardo O.; Magalhaes, Marco A.; Lipinski, Michael J.; Torguson, Rebecca; Waksman, Ron

    2014-01-01

    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

  13. Outcomes by Mode of Transport of ST Elevation MI Patients in the United Arab Emirates.

    Science.gov (United States)

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

    2017-04-01

    The purpose of this multicenter study was to assess differences in demographics, medical history, treatment times, and follow-up status among patients with ST-elevation myocardial infarction (STEMI), who were transported to the hospital by emergency medical services (EMS) or by private vehicle, or were transferred from other medical facilities. This multicenter study involved the collection of both retrospective and prospective data from 455 patients admitted to four hospitals in Abu Dhabi. We collected electronic medical records from EMS and hospitals, and conducted interviews with patients in person or via telephone. Chi-square tests and Kruskal-Wallis tests were used to examine differences in variables by mode of transportation. Results indicated significant differences in modes of transportation when considering symptom-onset-to-balloon time (p transported by EMS, private vehicle, or transferred from an outside facility were as follows: symptom-onset-to-balloon time in hours, 3.1 (1.8-4.3), 3.2 (2.1-5.3), and 4.5 (3.0-7.5), respectively; door-to-balloon time in minutes, 70 (48-78), 81 (64-105), and 62 (46-77), respectively. In all cases, EMS transportation was associated with a shorter time to treatment than other modes of transportation. However, the EMS group experienced greater rates of in-hospital events, including cardiac arrest and mortality, than the private transport group. Our results contribute data supporting EMS transportation for patients with acute coronary syndrome. Although a lack of follow-up data made it difficult to draw conclusions about long-term outcomes, our findings clearly indicate that EMS transportation can speed time to treatment, including time to balloon inflation, potentially reducing readmission and adverse events. We conclude that future efforts should focus on encouraging the use of EMS and improving transfer practices. Such efforts could improve outcomes for patients presenting with STEMI.

  14. 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.

  15. Cardiac rehabilitation in patients with ST-segment elevation myocardial infarction: can its failure be predicted?

    Science.gov (United States)

    Irzmański, Robert; Kapusta, Joanna; Obrębska-Stefaniak, Agnieszka; Urzędowicz, Beata; Kowalski, Jan

    2017-07-01

    The prognosis in patients after acute coronary syndromes (ACS) is significantly burdened by coexisting anaemia, leukocytosis and low glomerular filtration rate (GFR). Hyperglycaemia in the early stages of ACS is a strong predictor of death and heart failure in non-diabetic subjects. This study aimed to evaluate the effect of hyperglycaemia, anaemia, leukocytosis, thrombocytopaenia and decreased GFR on the risk of the failure of cardiac rehabilitation (phase II at the hospital) in post-ST-segment elevation myocardial infarction (STEMI) patients. The study included 136 post-STEMI patients, 96 men and 40 women, aged 60.1 ± 11.8 years, admitted for cardiac rehabilitation (phase II) to the Department of Internal Medicine and Cardiac Rehabilitation, WAM University Hospital in Lodz, Poland. On admission fasting blood cell count was performed and serum glucose and creatinine level was determined (GFR assessment). The following results were considered abnormal: glucose ⩾ 100 mg/dl, GFR 10 × 103/μl; platelets (PLTs) failure of cardiac rehabilitation. This risk has been defined on the basis of the patient's inability to tolerate workload increment >5 Watt in spite of the applied program of cardiac rehabilitation. As a result of building a logistic regression model, the most statistically significant risk factors were selected, on the basis of which cardiac rehabilitation failure index was determined. leukocytosis and reduced GFR determined most significantly the risk of failure of cardiac rehabilitation (respectively OR = 6.42 and OR = 3.29, p = 0.007). These parameters were subsequently utilized to construct a rehabilitation failure index. Peripheral blood cell count and GFR are important in assessing the prognosis of cardiac rehabilitation effects. leukocytosis and decreased GFR determine to the highest degree the risk of cardiac rehabilitation failure. Cardiac rehabilitation failure index may be useful in classifying patients into an appropriate model of

  16. N-terminal pro brain natriuretic peptide on admission for early risk stratification of patients with chest pain and no ST-segment elevation.

    Science.gov (United States)

    Jernberg, Tomas; Stridsberg, Mats; Venge, Per; Lindahl, Bertil

    2002-08-07

    The study evaluated the prognostic value of single measurement of N-terminal pro brain natriuretic peptide (NT-proBNP) obtained on admission in patients with symptoms suggestive of an acute coronary syndrome and no ST-segment elevation. Patients with symptoms suggestive of an acute coronary syndrome and no ST-segment elevation constitute a large and heterogeneous population. Early risk stratification has been based on clinical background factors, electrocardiography (ECG) and biochemical markers of myocardial damage. The neurohormonal activation has, so far, received less attention. The NT-proBNP was analyzed on admission in 755 patients admitted because of chest pain and no ST-segment elevation. Patients were followed concerning death for 40 months (median). The median NT-proBNP level was 400 (111 to 1646) ng/l. Compared to the lowest quartile, patients in the second, third and fourth quartiles had a relative risk of subsequent death of 4.2 (1.6 to 11.1), 10.7 (4.2 to 26.8) and 26.6 (10.8 to 65.5), respectively. When NT-proBNP was added to a Cox regression model including clinical background factors, ECG and troponin T, the NT-proBNP levels were independently associated with prognosis. A single measurement of NT-proBNP on admission will substantially improve the early risk stratification of patients with symptoms suggestive of an acute coronary syndrome and no ST-segment elevation. A combination of clinical background factors, ECG, troponin T and NT-proBNP obtained on admission will provide a highly discerning tool for risk stratification and further clinical decisions.

  17. Low QRS Voltage on Presenting Electrocardiogram Predicts Multi-vessel Disease in Anterior ST-segment Elevation Myocardial Infarction.

    Science.gov (United States)

    Kobayashi, Akihiro; Misumida, Naoki; Aoi, Shunsuke; Kanei, Yumiko

    Low QRS voltage was reported to predict adverse outcomes in acute myocardial infarction in the pre-thrombolytic era. However, the association between low voltage and angiographic findings has not been fully addressed. We performed a retrospective analysis of patients with anterior ST-segment elevation myocardial infarction (STEMI). Low QRS voltage was defined as either peak to peak QRS complex voltage voltage. Patients with low voltage had a higher rate of multi-vessel disease (MVD) (76% vs. 52%, p=0.01). Patients with low voltage were more likely to undergo coronary artery bypass grafting (CABG) during admission (11% vs. 2%, p=0.028). Low voltage was an independent predictor for MVD (OR 2.50; 95% CI 1.12 to 6.03; p=0.032). Low QRS voltage was associated with MVD and in-hospital CABG in anterior STEMI. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. 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...

  19. Pre-hospital ticagrelor in ST-segment elevation myocardial infarction in the French ATLANTIC population

    DEFF Research Database (Denmark)

    Cayla, Guillaume; Lapostolle, Frederic; Ecollan, Patrick

    2017-01-01

    BACKGROUND: ATLANTIC was a randomized study comparing pre- and in-hospital treatment with a ticagrelor loading dose (LD) in ongoing ST-segment elevation myocardial infarction (STEMI). We sought to compare patient characteristics and clinical outcomes in France with other countries participating...... in ATLANTIC. METHODS: The population comprised 1862 patients, 660 (35.4%) from France and 1202 from 12 other countries. The main endpoints were reperfusion (≥70% ST-segment elevation resolution) and TIMI flow grade 3 before (co-primary endpoints) and after percutaneous coronary intervention (PCI). Other...... endpoints included a composite ischaemic endpoint (death/myocardial infarction/stroke/urgent revascularization/definite stent thrombosis) and bleeding events at 30days. RESULTS: In France, median times from first LD to angiography and between first and second LDs were 49 and 35min, respectively, and were...

  20. 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.

  1. Outcomes by Mode of Transport of ST Elevation MI Patients in the United Arab Emirates

    OpenAIRE

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

    2017-01-01

    Introduction The purpose of this multicenter study was to assess differences in demographics, medical history, treatment times, and follow-up status among patients with ST-elevation myocardial infarction (STEMI), who were transported to the hospital by emergency medical services (EMS) or by private vehicle, or were transferred from other medical facilities. Methods This multicenter study involved the collection of both retrospective and prospective data from 455 patients admitted to four hosp...

  2. Elevated leukocyte count and adverse hospital events in patients with acute coronary syndromes: findings from the Global Registry of Acute Coronary Events (GRACE).

    Science.gov (United States)

    Furman, Mark I; Gore, Joel M; Anderson, Fredrick A; Budaj, Andrzej; Goodman, Shaun G; Avezum, Avaro; López-Sendón, José; Klein, Werner; Mukherjee, Debabrata; Eagle, Kim A; Dabbous, Omar H; Goldberg, Robert J

    2004-01-01

    To examine the association between elevated leukocyte count and hospital mortality and heart failure in patients enrolled in the multinational, observational Global Registry of Acute Coronary Events (GRACE). Elevated leukocyte count is associated with adverse hospital outcomes in patients presenting with acute myocardial infarction (AMI). The association of this prognostic factor with hospital mortality and heart failure in patients with other acute coronary syndromes (ACS) is unclear. We examined the association between admission leukocyte count and hospital mortality and heart failure in 8269 patients presenting with an ACS. This association was examined separately in patients with ST-segment elevation AMI, non-ST-segment elevation AMI, and unstable angina. Leukocyte count was divided into 4 mutually exclusive groups (Q): Q1 12,000. Multiple logistic regression analysis was performed to examine the association between elevated leukocyte count and hospital events while accounting for the simultaneous effect of several potentially confounding variables. Increasing leukocyte count was significantly associated with hospital death (adjusted odds ratio [OR] 2.8, 95% CI 2.1-3.6 for Q4 compared to Q2 [normal range]) and heart failure (OR 2.7, 95% CI 2.2-3.4) for patients presenting with ACS. This association was seen in patients with ST-segment elevation AMI (OR for hospital death 3.2, 95% CI 2.1-4.7; OR for heart failure 2.4, 95% CI 1.8-3.3), non-ST-segment elevation AMI (OR for hospital death 1.9, 95% CI 1.2-3.0; OR for heart failure 1.7, 95% CI 1.1-2.5), or unstable angina (OR for hospital death 2.8, 95% CI 1.4-5.5; OR for heart failure 2.0, 95% CI 0.9-4.4). In men and women of all ages with the spectrum of ACS, initial leukocyte count is an independent predictor of hospital death and the development of heart failure.

  3. Managing in-hospital quality improvement: An importance-performance analysis to set priorities for ST-elevation myocardial infarction care.

    Science.gov (United States)

    Aeyels, Daan; Seys, Deborah; Sinnaeve, Peter R; Claeys, Marc J; Gevaert, Sofie; Schoors, Danny; Sermeus, Walter; Panella, Massimiliano; Bruyneel, Luk; Vanhaecht, Kris

    2018-02-01

    A focus on specific priorities increases the success rate of quality improvement efforts for broad and complex-care processes. Importance-performance analysis presents a possible approach to set priorities around which to design and implement effective quality improvement initiatives. Persistent variation in hospital performance makes ST-elevation myocardial infarction care relevant to consider for importance-performance analysis. The purpose of this study was to identify quality improvement priorities in ST-elevation myocardial infarction care. Importance and performance levels of ST-elevation myocardial infarction key interventions were combined in an importance-performance analysis. Content validity indexes on 23 ST-elevation myocardial infarction key interventions of a multidisciplinary RAND Delphi Survey defined importance levels. Structured review of 300 patient records in 15 acute hospitals determined performance levels. The significance of between-hospital variation was determined by a Kruskal-Wallis test. A performance heat-map allowed for hospital-specific priority setting. Seven key interventions were each rated as an overall improvement priority. Priority key interventions related to risk assessment, timely reperfusion by percutaneous coronary intervention and secondary prevention. Between-hospital performance varied significantly for the majority of key interventions. The type and number of priorities varied strongly across hospitals. Guideline adherence in ST-elevation myocardial infarction care is low and improvement priorities vary between hospitals. Importance-performance analysis helps clinicians and management in demarcation of the nature, number and order of improvement priorities. By offering a tailored improvement focus, this methodology makes improvement efforts more specific and achievable.

  4. Clinical outcomes with the STENTYS self-apposing coronary stent in patients presenting with ST-segment elevation myocardial infarction: two-year insights from the APPOSITION III (A Post-Market registry to assess the STENTYS self-exPanding COronary Stent In AcuTe MyocardIal InfarctiON) registry.

    Science.gov (United States)

    Lu, Huangling; Grundeken, Maik J; Vos, Nicola S; IJsselmuiden, Alexander J J; van Geuns, Robert-Jan; Wessely, Rainer; Dengler, Thomas; La Manna, Alessio; Silvain, Johanne; Montalescot, Gilles; Spaargaren, René; Tijssen, Jan G P; Amoroso, Giovanni; de Winter, Robbert J; Koch, Karel T

    2017-08-04

    The APPOSITION III registry evaluated the feasibility and performance of the STENTYS self-apposing stent in an ST-segment elevation myocardial infarction (STEMI) population. This novel self-apposing stent device lowers stent strut malapposition rates and therefore carries the potential to prevent stent undersizing during primary percutaneous coronary intervention (PCI) in STEMI patients. To date, no long-term data are available using this device in the setting of STEMI. We aimed to evaluate the long-term clinical outcomes of the APPOSITION III registry. This was an international, prospective, multicentre post-marketing registry. The study population consisted of 965 STEMI patients. The primary endpoint, major adverse cardiac events (MACE), was defined as the composite of cardiac death, recurrent target vessel myocardial infarction (TV-MI), and clinically driven target lesion revascularisation (CD-TLR). At two years, MACE occurred in 11.2%, cardiac death occurred in 2.3%, TV-MI occurred in 2.3% and CD-TLR in 9.2% of patients. The two-year definite stent thrombosis (ST) rate was 3.3%. Incremental event rates between one- and two-year follow-up were 1.0% for TV-MI, 1.8% for CD-TLR, and 0.5% for definite ST. Post-dilation resulted in significantly reduced CD-TLR and ST rates at 30-day landmark analyses. Results were equivalent between the BMS and PES STENTYS subgroups. This registry revealed low rates of adverse events at two-year follow-up, with an incremental ST rate as low as 0.5% in the second year, demonstrating that the self-apposing technique is feasible in STEMI patients on long-term follow-up while using post-dilatation.

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    BACKGROUND: Current guidelines recommend that comatose out-of-hospital cardiac arrest patients with ST-segment elevations (STEs) following return of spontaneous circulation (ROSC) should be referred for an acute coronary angiography. We sought to investigate the diagnostic value of the pre......-hospital ROSC-ECG in predicting ST-elevation myocardial infarction (STEMI). METHOD: ROSC-ECGs of 145 comatose survivors of out-of-hospital cardiac arrest, randomly assigned in the Target Temperature Management trial, were classified according to the current STEMI ECG criteria (third universal definition...... interval (CI) 62-84), specificity of 65% (95% CI 53-75) and a positive and negative predictive value of 65% (95% CI 54-76) and 73% (95% CI 61-83) in predicting STEMI. Time to ROSC was significantly longer (24 minutes vs. 19 minutes, P=0.02) in STE compared with no STE patients. Percutaneous coronary...

  6. Impact of Admission Blood Glucose on Coronary Collateral Flow in Patients with ST-Elevation Myocardial Infarction.

    Science.gov (United States)

    Kurmus, Ozge; Aslan, Turgay; Ekici, Berkay; Baglan Uzunget, Sezen; Karaarslan, Sukru; Tanindi, Asli; Erkan, Aycan Fahri; Akgul Ercan, Ebru; Kervancıoglu, Celal

    2018-01-01

    In patients with acute myocardial infarction, glucose metabolism is altered and acute hyperglycemia on admission is common regardless of diabetes status. The development of coronary collateral is heterogeneous among individuals with coronary artery disease. In this study, we aimed to investigate whether glucose value on admission is associated with collateral flow in ST-elevation myocardial infarction (STEMI) patients. We retrospectively evaluated 190 consecutive patients with a diagnosis of first STEMI within 12 hours of onset of chest pain. Coronary collateral development was graded according to Rentrop classification. Rentrop 0-1 was graded as poor collateral development, and Rentrop 2-3 was graded as good collateral development. Admission glucose was measured and compared between two groups. Mean admission glucose level was 173.0 ± 80.1 mg/dl in study population. Forty-five (23.7%) patients had good collateral development, and 145 (76.3%) patients had poor collateral development. There were no statistically significant differences in demographic characteristics between two groups. Three-vessel disease was more common in patients with good collateral development ( p =0.026). Mean admission glucose level was higher in patients with poor collateral than good collateral (180.6 ± 84.9 mg/dl versus 148.7 ± 56.6 mg/dl, resp., p =0.008). In univariate analysis, higher admission glucose was associated with poor collateral development, but multivariate logistic regression analysis revealed a borderline result (odds ratio 0.994, 95% CI 0.989-1.000, p =0.049). Our results suggest that elevated glucose on admission may have a role in the attenuation of coronary collateral blood flow in acute myocardial infarction. Further studies are needed to validate our results.

  7. Usefulness of ST elevation score by using vector-projected virtual 187-channel ECG for risk stratification in patients with Brugada-type ECG pattern

    Directory of Open Access Journals (Sweden)

    Shoko Ishikawa

    2012-08-01

    Conclusion: The ST elevation score in VP-ECG objectively documented the degree of ST elevation in surface ECG in Brugada-type ECG patterns. The ST-elevation score might be useful for risk stratification in patients with asymptomatic Brugada syndrome.

  8. Elevated serum uric acid affects myocardial reperfusion and infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

    Science.gov (United States)

    Mandurino-Mirizzi, Alessandro; Crimi, Gabriele; Raineri, Claudia; Pica, Silvia; Ruffinazzi, Marta; Gianni, Umberto; Repetto, Alessandra; Ferlini, Marco; Marinoni, Barbara; Leonardi, Sergio; De Servi, Stefano; Oltrona Visconti, Luigi; De Ferrari, Gaetano M; Ferrario, Maurizio

    2018-05-01

    Elevated serum uric acid (eSUA) was associated with unfavorable outcome in patients with ST-segment elevation myocardial infarction (STEMI). However, the effect of eSUA on myocardial reperfusion injury and infarct size has been poorly investigated. Our aim was to correlate eSUA with infarct size, infarct size shrinkage, myocardial reperfusion grade and long-term mortality in STEMI patients undergoing primary percutaneous coronary intervention. We performed a post-hoc patients-level analysis of two randomized controlled trials, testing strategies for myocardial ischemia/reperfusion injury protection. Each patient underwent acute (3-5 days) and follow-up (4-6 months) cardiac magnetic resonance. Infarct size and infarct size shrinkage were outcomes of interest. We assessed T2-weighted edema, myocardial blush grade (MBG), corrected Thrombolysis in myocardial infarction Frame Count, ST-segment resolution and long-term all-cause mortality. A total of 101 (86.1% anterior) STEMI patients were included; eSUA was found in 16 (15.8%) patients. Infarct size was larger in eSUA compared with non-eSUA patients (42.3 ± 22 vs. 29.1 ± 15 ml, P = 0.008). After adjusting for covariates, infarct size was 10.3 ml (95% confidence interval 1.2-19.3 ml, P = 0.001) larger in eSUA. Among patients with anterior myocardial infarction the difference in delayed enhancement between groups was maintained (respectively, 42.3 ± 22.4 vs. 29.9 ± 15.4 ml, P = 0.015). Infarct size shrinkage was similar between the groups. Compared with non-eSUA, eSUA patients had larger T2-weighted edema (53.8 vs. 41.2 ml, P = 0.031) and less favorable MBG (MBG < 2: 44.4 vs. 13.6%, P = 0.045). Corrected Thrombolysis in myocardial infarction Frame Count and ST-segment resolution did not significantly differ between the groups. At a median follow-up of 7.3 years, all-cause mortality was higher in the eSUA group (18.8 vs. 2.4%, P = 0.028). eSUA may affect myocardial

  9. Clinical benefit of drugs targeting mitochondrial function as an adjunct to reperfusion in ST-segment elevation myocardial infarction

    DEFF Research Database (Denmark)

    Campo, Gianluca; Pavasini, Rita; Morciano, Giampaolo

    2017-01-01

    AIMS: To perform a systematic review and meta-analysis of randomized clinical trials (RCT) comparing the effectiveness of drugs targeting mitochondrial function vs. placebo in patients with ST-segment elevation myocardial infarction (STEMI) undergoing mechanical coronary reperfusion. METHODS...

  10. 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....

  11. Estrategias de reperfusión usadas en pacientes con síndrome coronario agudo con elevación persistente del segmento ST en un hospital general: Reperfusion strategies in patients with acute coronary syndrome and persistent ST-segment elevation in a general hospital

    Directory of Open Access Journals (Sweden)

    Luis Borda-Velásquez

    2015-01-01

    Full Text Available Objetivos: Conocer las estrategias de reperfusión en pacientes con síndrome coronario agudo ST elevado (SCASTE atendidos en el departamento de emergencia de un hospital general, y determinar el tiempo para realizar dichas estrategias a través de los tiempos puerta-aguja (P-A, puerta-balón (P-B, electrocardiograma (ECG y total de isquemia. Material y métodos: Estudio retrospectivo transversal en pacientes con diagnóstico de SCASTE en el Hospital Nacional Cayetano Heredia (HNCH desde el 1° de enero de 2011 al 31 de enero de 2013. Se registraron las características demográficas y clínicas, tiempos de reperfusión miocárdica, de síntomas, para toma de ECG. Los factores asociados fueron analizados por análisis bivariado. Resultados: Cuarenta y cinco pacientes fueron elegibles. La edad media fue 60,5 ± 10,98 años, 88,8% fueron varones. El tiempo medio de hospitalización fue 9,79 ± 10,36 días. Se encontró obesidad (IMC ≥ 30 en 61,3%; hipertensión en 40,9%: tabaquismo en 43,1%; y diabetes mellitus II (DM II en 25%. El tiempo medio P-A de 57 ± 54,1 minutos; en 28,1% se administró el agente trombolítico antes de los 30 minutos. Angioplastia fue realizada en un paciente con un tiempo P-B de 440 minutos. El tiempo total de isquemia (TTI medio fue 244 ± 143,9 minutos. Conclusiones: Las estrategias de reperfusión fueron usadas en 71,1% de pacientes, siendo trombólisis la más usada; sin embargo, el tiempo P-A se encontró fuera del rango óptimo

  12. Reversible Stress Cardiomyopathy Presenting as Acute Coronary Syndrome with Elevated Troponin in the Absence of Regional Wall Motion Abnormalities: A Forme Fruste of Stress Cardiomyopathy?

    Directory of Open Access Journals (Sweden)

    Mahesh Anantha Narayanan

    2014-01-01

    Full Text Available We present a case of reversible stress cardiomyopathy in a surgical patient, described here as a forme fruste due to its atypical features. It is important to recognize such unusual presentation of stress cardiomyopathy that mimics acute coronary syndrome. Stress cardiomyopathy commonly presents as acute coronary syndrome and is characterized by typical or atypical variants of regional wall motion abnormalities. We report a 60-year-old Caucasian male with reversible stress cardiomyopathy following a sternal fracture fixation. Although the patient had several typical features of stress cardiomyopathy including physical stress, ST-segment elevation, elevated cardiac biomarkers and normal epicardial coronaries, there were few features that were atypical, including unusual age, gender, absence of regional wall motion abnormalities, high lateral ST elevation, and high troponin-ejection fraction product. In conclusion, this could represent a forme fruste of stress cardiomyopathy.

  13. Prognostic Value of Serial ST2 Measurements in Patients With Acute Heart Failure

    NARCIS (Netherlands)

    van Vark, Laura C.; Lesman-Leegte, Ivonne; Baart, Sara J.; Postmus, Douwe; Pinto, Yigal M.; Orsel, Joke G.; Westenbrink, B. Daan; Brunner-la Rocca, Hans P.; van Miltenburg, Addy J. M.; Boersma, Eric; Hillege, Hans L.; Akkerhuis, K. Martijn

    2017-01-01

    Several clinical studies have evaluated the association between ST2 and outcome in patients with heart failure (HF). However, little is known about the predictive value of frequently measured ST2 levels in patients with acute HF. This study sought to describe the prognostic value of baseline and

  14. Proteomics in Hypothermia as Adjunctive Therapy in Patients with ST-Segment Elevation Myocardial Infarction

    DEFF Research Database (Denmark)

    Mohammad, Moman A; Noc, Marco; Lang, Irene

    2017-01-01

    Cardiovascular and inflammatory biomarkers in therapeutic hypothermia have been studied in cardiac arrest, but data on patients with ST-segment elevation myocardial infarction (STEMI) treated with therapeutic hypothermia are currently unavailable. A multiplex proximity extension assay allowed us...... patients with STEMI, randomized to hypothermia as adjunctive therapy to percutaneous coronary intervention (PCI) or standard care with PCI only. Blood samples were obtained at baseline (0 hour), 6, 24, and 96 hours post PCI, and stored at -80°C until they were analyzed by PROSEEK Multiplex CVD and PROSEEK...... in the hypothermia group as compared with the control group. In addition, seven markers were slightly elevated in the hypothermia group (OPG, FGF21, FS, IL12B, PRL, TIM, IL6). In a prespecified subgroup analysis of anterior infarctions, two additional markers were reduced (PTX3 and SELE). In this explorative...

  15. Predictive value of elevated neutrophil to lymphocyte ratio in patients undergoing primary angioplasty for ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Ergelen, Mehmet; Uyarel, Huseyin; Altay, Servet; Kul, Şeref; Ayhan, Erkan; Isık, Turgay; Kemaloğlu, Tuba; Gül, Mehmet; Sönmez, Osman; Erdoğan, Ercan; Turfan, Murat

    2014-05-01

    The neutrophil to lymphocyte ratio (NLR) has been investigated as a new predictor for cardiovascular risk. Admission NLR would be predictive of adverse outcomes after primary angioplasty for ST-segment elevation myocardial infarction (STEMI). A total of 2410 patients with STEMI undergoing primary angioplasty were retrospectively enrolled. The study population was divided into tertiles based on the NLR values. A high NLR (n = 803) was defined as a value in the third tertile (>6.97), and a low NLR (n = 1607) was defined as a value in the lower 2 tertiles (≤6.97). High NLR group had higher incidence of inhospital and long-term cardiovascular mortality (5% vs 1.4%, P 6.97) was found as an independent predictor of inhospital cardiovascular mortality (odds ratio: 2.8, 95% confidence interval: 1.37-5.74, P = .005). High NLR level is associated with increased inhospital and long-term cardiovascular mortality in patients with STEMI undergoing primary angioplasty.

  16. Local Matrix Metalloproteinase 9 Level Determines Early Clinical Presentation of ST-Segment-Elevation Myocardial Infarction.

    Science.gov (United States)

    Nishiguchi, Tsuyoshi; Tanaka, Atsushi; Taruya, Akira; Emori, Hiroki; Ozaki, Yuichi; Orii, Makoto; Shiono, Yasutsugu; Shimamura, Kunihiro; Kameyama, Takeyoshi; Yamano, Takashi; Yamaguchi, Tomoyuki; Matsuo, Yoshiki; Ino, Yasushi; Kubo, Takashi; Hozumi, Takeshi; Hayashi, Yasushi; Akasaka, Takashi

    2016-12-01

    Early clinical presentation of ST-segment-elevation myocardial infarction (STEMI) and non-ST-segment-elevation myocardial infarction affects patient management. Although local inflammatory activities are involved in the onset of MI, little is known about their impact on early clinical presentation. This study aimed to investigate whether local inflammatory activities affect early clinical presentation. This study comprised 94 and 17 patients with MI (STEMI, 69; non-STEMI, 25) and stable angina pectoris, respectively. We simultaneously investigated the culprit lesion morphologies using optical coherence tomography and inflammatory activities assessed by shedding matrix metalloproteinase 9 (MMP-9) and myeloperoxidase into the coronary circulation before and after stenting. Prevalence of plaque rupture, thin-cap fibroatheroma, and lipid arc or macrophage count was higher in patients with STEMI and non-STEMI than in those with stable angina pectoris. Red thrombus was frequently observed in STEMI compared with others. Local MMP-9 levels were significantly higher than systemic levels (systemic, 42.0 [27.9-73.2] ng/mL versus prestent local, 69.1 [32.2-152.3] ng/mL versus poststent local, 68.0 [35.6-133.3] ng/mL; Pclinical presentation in patients with MI. Local inflammatory activity for atherosclerosis needs increased attention. © 2016 American Heart Association, Inc.

  17. Complete revascularisation versus treatment of the culprit lesion only in patients with ST-segment elevation myocardial infarction and multivessel disease (DANAMI-3—PRIMULTI)

    DEFF Research Database (Denmark)

    Engstrøm, Thomas; Kelbæk, Henning; Helqvist, Steffen

    2015-01-01

    BACKGROUND: Patients with acute ST-segment elevation myocardial infarction (STEMI) and multivessel coronary disease have a worse prognosis compared with individuals with single-vessel disease. We aimed to study the clinical outcome of patients with STEMI treated with fractional flow reserve (FFR...... electronically via a web-based system in permuted blocks of varying size by the clinician who did the primary PCI. All patients received best medical treatment. The primary endpoint was a composite of all-cause mortality, non-fatal reinfarction, and ischaemia-driven revascularization of lesions in non...

  18. 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.

  19. Evans syndrome with non-ST segment elevation myocardial infarction complicated by hemopericardium

    Directory of Open Access Journals (Sweden)

    Filiz Kizilirmak

    2016-09-01

    Full Text Available Evans syndrome (ES is a rare hematological disease characterized by autoimmune hemolytic anemia, immune thrombocytopenia, and/or neutropenia, all of which may be seen simultaneously or subsequently. Thrombotic events in ES are uncommon. Furthermore, non-ST segment-elevation myocardial infarction (NSTEMI during ES is a very rare condition. Here, we describe a case of a 69-year-old female patient presenting with NSTEMI and ES. Revascularization via percutaneous coronary intervention (PCI was scheduled and performed. Hemopericardium and cardiac tamponade occurred 5 h after PCI, and urgent pericardiocentesis was performed. Follow-up was uneventful, and the patient was safely discharged. Early recognition and appropriate management of NSTEMI is crucial to prevent morbidity and mortality. Coexistence of NSTEMI and ES, which is associated with increased bleeding risk, is a challenging scenario and these patients should be closely monitored in order to achieve early recognition and treatment of complications.

  20. 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.

  1. Usefulness of the troponin-ejection fraction product to differentiate stress cardiomyopathy from ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Nascimento, Francisco O; Yang, Solomon; Larrauri-Reyes, Maiteder; Pineda, Andres M; Cornielle, Vertilio; Santana, Orlando; Heimowitz, Todd B; Stone, Gregg W; Beohar, Nirat

    2014-02-01

    The presentation of stress cardiomyopathy (SC) with nonobstructive coronary artery disease mimics that of ST-segment elevation myocardial infarction (STEMI) due to coronary occlusion. No single parameter has been successful in differentiating the 2 entities. We thus sought to develop a noninvasive clinical tool to discriminate between these 2 conditions. We retrospectively reviewed 59 consecutive cases of SC at our institution from July 2005 through June 2011 and compared those with 60 consecutives cases of angiographically confirmed STEMI treated with primary percutaneous coronary intervention in the same period. All patients underwent acute echocardiography, and the peak troponin I level was determined. The troponin-ejection fraction product (TEFP) was derived by multiplying the peak troponin I level and the echocardiographically derived left ventricular ejection fraction. Comparing the SC and STEMI groups, the mean left ventricular ejection fraction at the time of presentation was 30 ± 9% versus 44 ± 11%, respectively (p statistic 0.91 ± 0.02, p <0.001). In conclusion, for patients not undergoing emergent angiography, the TEFP may be used with high accuracy to differentiate SC with nonobstructive coronary artery disease from true STEMI due to coronary occlusion. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Simultaneous right coronary artery spasm in a patient with Anterior ST-Segment Elevation Myocardial Infarction: a case report

    Directory of Open Access Journals (Sweden)

    Zhiva Taherpour

    2013-05-01

    Full Text Available Please cite this article as: Taherpour Z, Seyedian M, Alasti M. Simultaneous right coronary artery spasm in a patient with Anterior ST-Segment Elevation Myocardial Infarction: a case report. Novel Biomed 2013;1:29-33.Simultaneous occlusion of two vessels causing infarction at different territories is an uncommon finding. We report simultaneous right ventricular and anterior ST-segment elevation myocardial infarction in a previously healthy young man.The angiographic results demonstrated the simultaneous occlusion of the right and left coronary arteries because of simultaneous occlusion of left anterior descending artery (LADA and spasm of right coronary artery (RCA. In this patient, we found simultaneous ST elevations in right and precordial leads so everyone should be careful about all leads of the surface electrocardiogram for decision making in the management of a patient.

  3. 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.

  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 s......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 pullbacks suitable for analysis. Safety parameters included the frequency of peri-procedural complications, and major adverse cardiac events (MACE), a composite of cardiac death, myocardial infarction (MI) and any clinically-indicated revascularization at 2 years. Clinical outcomes were compared...

  5. Reperfusion therapy in ST-segment elevation myocardial infarction in the Veteran Administration Caribbean Healthcare System; search for improvement.

    Science.gov (United States)

    Escabí-Mendoza, José

    2008-01-01

    Patients that present with acute STEMI have proven morbidity and mortality benefit from early reperfusion therapy. The American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend either fibrinolytic therapy within 30 minutes or a primary percutaneous coronary intervention (PPCI) within 90 minutes of patients arrival to the Emergency Department. Despite these recommendations, some patients do not receive reperfusion therapy and less than half receive it on time. Describe and analyze our reperfusion therapy performance in patients presenting with acute ST segment elevation myocardial infarct (STEMI) in the Veteran Administration Caribbean Healthcare System (VACHS), and determine potential causes for reperfusion therapy delays and develop strategies and a tailored algorithm according to our clinical findings and available institutional resources. Retrospective analysis of patients admitted to the VACHS with a discharge diagnosis of STEMI, from 01/01/2007 until 04/10/2008. A total of 55 patients met inclusion criteria for STEMI diagnosis. Of these, only 30 patients had active indication for reperfusion therapy. Reperfusion therapy was given in 97% of the cases, 69% with PPCI and 31% with fibrinolytic therapy (tenecteplase). In general the selection of reperfusion therapy seemed adherent to ACC/AHA STEMI guidelines. The reperfusion time goal was superior with thrombolytic therapy compared to PPCI, with 43% and 15% respectively. PPCI performed off regular tour of duty was significantly delayed compared to regular day shift, with a mean time of 221 and 113 minutes respectively (p=0.027). Most of the patients presenting with STEMI to the VACHS undergo reperfusion therapy. PPCI was the most frequent selected reperfusion approach. The PPCI time goal was infrequently met. The most significant cause for PPCI delay was related to performance off regular tour of duty. These finding support the implementation of a tailored STEMI reperfusion algorithm

  6. 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.

  7. Renoprotective effect of remote ischemic postconditioning in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Cao B

    2018-02-01

    Full Text Available Bangming Cao,* Chi Zhang,* Haipeng Wang, Ming Xia, Xiangjun Yang Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China *These authors contributed equally to this work Background: Whether upper arm remote ischemic postconditioning (RIPostC exerts protection to kidney in patients with ST-elevation myocardial infarction (STEMI undergoing primary percutaneous coronary intervention (PPCI remains unknown. Methods: Sixty-four patients with STEMI were randomized to PPCI + RIPostC (n=29 and PPCI (n=35 groups. RIPostC consisting of 4 cycles of 5 minutes occlusion/reperfusion by cuff inflation/deflation of the upper arm was started within 1 minute after the first balloon dilatation. Peripheral venous blood samples were collected before PPCI and at 0.5, 8, 24, 48, and 72 hours after PPCI to detect serum creatinine (SCr and creatine kinase-MB (CK-MB. Acute kidney injury (AKI rate and estimated glomerular filtration rate (eGFR were calculated. The transthoracic echocardiography was performed 7 days after PPCI to assess left ventricular ejection fraction (LVEF. Results: The patients in the PPCI + RIPostC group had a lower AKI rate compared with those in the PPCI group (P=0.04. The eGFR after PPCI increased in the PPCI + RIPostC group compared to the PPCI group (P<0.01. The peak of CK-MB concentration in the PPCI + RIPostC group was significantly lower than that in the PPCI group (P<0.01. The area under the curve of CK-MB decreased in the PPCI + RIPostC group compared with that in the PPCI group. LVEF in the PPCI + RIPostC group was significantly higher than that in the PPCI group (P=0.04. Conclusion: Upper arm RIPostC exerts renal and cardiac protection following cardiac ischemia–reperfusion in patients with STEMI. Keywords: myocardial ischemia reperfusion, ST-segmental elevation myocardial infarction, primary percutaneous coronary intervention, remote ischemic postconditioning

  8. 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)

    Padma, S.; Zachariah, M.; Haridas, K.K.

    2004-01-01

    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 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 99m Tc 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

  9. 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)

    Padma, S; Zachariah, M.; Haridas, K K

    2004-01-01

    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 99m Tc 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

  10. Relationship between Serum Inflammatory Biomarkers and Thrombus Characteristics in Patients with ST Segment Elevation Myocardial Infarction.

    Science.gov (United States)

    Niccoli, Giampaolo; Menozzi, Alberto; Capodanno, Davide; Trani, Carlo; Sirbu, Vasile; Fineschi, Massimo; Zara, Chiara; Crea, Filippo; Trabattoni, Daniela; Saia, Francesco; Ladich, Elena; Biondi Zoccai, Giuseppe; Attizzani, Guilherme; Guagliumi, Giulio

    2017-01-01

    To compare angiographic and optical coherence tomography (OCT) data pertinent to thrombi, along with the histologic characteristics of aspirated thrombi in patients presenting with ST elevation myocardial infarction (STEMI) with or without inflammation, as assessed by C-reactive protein (CRP) and myeloperoxidase (MPO). In the OCTAVIA (Optical Coherence Tomography Assessment of Gender Diversity in Primary Angioplasty) study, 140 patients with STEMI referred for primary percutaneous intervention were enrolled. The patients underwent OCT assessment of the culprit vessel, along with blood sampling of CRP and MPO, and histologic analysis of the thrombus. Biomarkers were available for 129 patients, and histology and immunohistochemistry of the thrombi were available for 78 patients. Comparisons were made using the median thresholds of CRP and MPO (2.08 mg/L and 604.124 ng/mL, respectively). There was no correlation between CRP and MPO levels in the whole population (p = 0.685). Patients with high CRP levels had higher thrombus grades and more frequent TIMI flow 0/1 compared with those with low CRP levels (5 [1st quartile 3; 3rd quartile 5] vs. 3.5 mg/L [1; 5], p = 0.007, and 69.3 vs. 48.5%, p = 0.04, respectively). Patients with high MPO levels more commonly had early thrombi than had those with low MPO levels (42.5 vs. 20.0%, p = 0.04). CRP and MPO were not correlated in STEMI patients, possibly reflecting different pathogenic mechanisms, with CRP more related to thrombus burden and MPO to thrombus age. © 2016 S. Karger AG, Basel.

  11. Short and long-term survival after primary percutaneous coronary intervention in young patients with ST-elevation myocardial infarction

    DEFF Research Database (Denmark)

    Waziri, Homa; Jørgensen, Erik; Kelbæk, Henning

    2016-01-01

    UNLABELLED: The long-term prognosis of patients with ST-elevation myocardial infarction (STEMI) aged 45 years or younger and differences according to gender have not been well characterized. METHODS: We included 16,685 consecutive STEMI patients from 2003 to 2012 (67,992 patient-years follow-up) ...

  12. 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...

  13. Comparison of Selvester QRS score with magnetic resonance imaging measured infarct size in patients with ST elevation myocardial infarction

    DEFF Research Database (Denmark)

    Carlsen, Esben A; Bang, Lia E; Ahtarovski, Kiril A

    2012-01-01

    Recent studies have shown that the Selvester QRS score is significantly correlated with delayed enhancement-magnetic resonance imaging (DE-MRI) measured myocardial infarct (MI) size in reperfused ST elevation MI (STEMI). This study further tests the hypothesis that Selvester QRS score correlates...

  14. Left atrial volume and function in patients following ST elevation myocardial infarction and the association with clinical outcome

    DEFF Research Database (Denmark)

    Lønborg, Jacob Thomsen; Engstrøm, Thomas; Møller, Jacob Eifer

    2013-01-01

    The left atrium (LA) transfers blood to the left ventricle in a complex manner. LA function is characterized by passive emptying (LA passive fraction), active emptying (LA ejection fraction), and total emptying (LA fractional change). Despite this complexity, the clinical relevance of the LA is b...... function in patients following ST elevation myocardial infarction (STEMI)....

  15. Recognized Obstructive Sleep Apnea is Associated With Improved In-Hospital Outcomes After ST Elevation Myocardial Infarction.

    Science.gov (United States)

    Mohananey, Divyanshu; Villablanca, Pedro A; Gupta, Tanush; Agrawal, Sahil; Faulx, Michael; Menon, Venugopal; Kapadia, Samir R; Griffin, Brian P; Ellis, Stephen G; Desai, Milind Y

    2017-07-20

    Obstructive sleep apnea (OSA) is an independent risk factor for many cardiovascular conditions such as coronary artery disease, myocardial infarction, systemic hypertension, pulmonary hypertension, and stroke. However, the association of OSA with outcomes in patients hospitalized for ST-elevation myocardial infarction remains controversial. We used the nation-wide inpatient sample between 2003 and 2011 to identify patients with a primary discharge diagnosis of ST-elevation myocardial infarction and then used the International Classification of Diseases, Clinical Modification code 327.23 to identify a group of patients with OSA. The primary outcome of interest was in-hospital mortality, and secondary outcomes were in-hospital cardiac arrest, length of stay and hospital charges. Our cohort included 1 850 625 patients with ST-elevation myocardial infarction, of which 1.3% (24 623) had documented OSA. OSA patients were younger and more likely to be male, smokers, and have chronic pulmonary disease, depression, hypertension, known history of coronary artery disease, dyslipidemia, obesity, and renal failure ( P ST-elevation myocardial infarction patients with recognized OSA had significantly decreased mortality compared with patients without OSA. Although patients with OSA had longer hospital stays and incurred greater hospital charges, there was no difference in incidence of in-hospital cardiac arrest. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  16. Shock Index More Sensitive Than Cardiogenic Shock in ST-Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

    NARCIS (Netherlands)

    Hemradj, V.V.; Ottervanger, J.P.; Boer, M.J. de; Suryapranata, H.

    2017-01-01

    BACKGROUND: Cardiogenic shock (CS) is a strong predictor of mortality in patients with ST-elevation myocardial infarction (STEMI), but there is evidence that shock index (SI), taking into account both blood pressure and heart rate, is a more sensitive and powerful predictor. We investigated the

  17. Prehospital administration of tenecteplase for ST-segment elevation myocardial infarction in a rural EMS system.

    Science.gov (United States)

    Crowder, Joseph S; Hubble, Michael W; Gandhi, Sanjay; McGinnis, Henderson; Zelman, Stacie; Bozeman, William; Winslow, James

    2011-01-01

    In the setting of ST-segment elevation myocardial infarction (STEMI), early reperfusion yields better patient outcomes. Emergency medical services (EMS) is the first medical contact for half of the afflicted population, and prehospital thrombolysis may result in considerably faster reperfusion compared with percutaneous coronary intervention (PCI) in rural settings. However, there are few reports of prehospital thrombolysis in rural EMS systems. To describe a rural EMS system's experience with tenecteplase in STEMI. Data were retrospectively abstracted from the medical records of patients receiving tenecteplase using standard chart review guidelines. Primary outcomes included time saved by EMS-initiated thrombolysis, aborted infarctions, serious bleeding events, and in-hospital mortality. Secondary outcomes included reinfarction, rescue angioplasty, and appropriateness of treatment. Time savings was defined as transport time after tenecteplase administration plus 90 minutes, which is the typical door-to-balloon time for PCI laboratories. Aborted infarction was defined as resolution of the cumulative ST-segment elevation to ≤ 50% of that on the initial electrocardiogram (ECG) within two hours after treatment, and peak creatine kinase (CK)/CK-MB levels less than or equal to twice the upper limit of normal. Seventy-three patients received prehospital tenecteplase; this treatment was determined to be appropriate in 86.4% of cases. The mean patient age was 59 years, and 71.6% of the patients were male. Mean (± standard deviation) scene-arrival-to-drug time was 26.2 (± 11.4) minutes, the mean scene-arrival-to-hospital-arrival time was 73.0 (± 20.6) minutes, and the mean transport time was 46.0 (± 11.1) minutes. Tenecteplase was administered 35.9 (± 25.0) minutes prior to hospital arrival, and the estimated reperfusion time savings over PCI was 125.9 (± 25.0) minutes. Aborted infarctions were observed in 24.1% of patients, whereas 9.6% suffered reinfarction, 47

  18. Chest-lead ST-J amplitudes using arm electrodes as reference instead of the Wilson central terminal in smartphone ECG applications: Influence on ST-elevation myocardial infarction criteria fulfillment.

    Science.gov (United States)

    Lindow, Thomas; Engblom, Henrik; Khoshnood, Ardavan; Ekelund, Ulf; Carlsson, Marcus; Pahlm, Olle

    2018-05-07

    "Smartphone 12-lead ECG" for the assessment of acute myocardial ischemia has recently been introduced. In the smartphone 12-lead ECG either the right or the left arm can be used as reference for the chest electrodes instead of the Wilson central terminal. These leads are labeled "CR leads" or "CL leads." We aimed to compare chest-lead ST-J amplitudes, using either CR or CL leads, to those present in the conventional 12-lead ECG, and to determine sensitivity and specificity for the diagnosis of STEMI for CR and CL leads. Five hundred patients (74 patients with ST elevation myocardial infarction (STEMI), 66 patients with nonischemic ST deviation and 360 controls) were included. Smartphone 12-lead ECG chest-lead ST-J amplitudes were calculated for both CR and CL leads. ST-J amplitudes were 9.1 ± 29 μV larger for CR leads and 7.7 ± 42 μV larger for CL leads than for conventional chest leads (V leads). Sensitivity and specificity were 94% and 95% for CR leads and 81% and 97% for CL leads when fulfillment of STEMI criteria in V leads was used as reference. In ischemic patients who met STEMI criteria in V leads, but not in limb leads, STEMI criteria were met with CR or CL leads in 91%. By the use of CR or CL leads, smartphone 12-lead ECG results in slightly lower sensitivity in STEMI detection. Therefore, the adjustment of STEMI criteria may be needed before application in clinical practice. © 2018 The Authors. Annals of Noninvasive Electrocardiology Published by Wiley Periodicals, Inc.

  19. Trends in Regionalization of Care for ST-Segment Elevation Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Renee Y. Hsia

    2017-09-01

    Full Text Available Introduction: California has led successful regionalized efforts for several time-critical medical conditions, including ST-segment elevation myocardial infarction (STEMI, but no specific mandated protocols exist to define regionalization of care. We aimed to study the trends in regionalization of care for STEMI patients in the state of California and to examine the differences in patient demographic, hospital, and county trends. Methods: Using survey responses collected from all California emergency medical services (EMS agencies, we developed four categories – no, partial, substantial, and complete regionalization – to capture prehospital and inter-hospital components of regionalization in each EMS agency’s jurisdiction between 2005–2014. We linked the survey responses to 2006 California non-public hospital discharge data to study the patient distribution at baseline. Results: STEMI regionalization-of-care networks steadily developed across California. Only 14% of counties were regionalized in 2006, accounting for 42% of California’s STEMI patient population, but over half of these counties, representing 86% of California’s STEMI patient population, reached complete regionalization in 2014. We did not find any dramatic differences in underlying patient characteristics based on regionalization status; however, differences in hospital characteristics were relatively substantial. Conclusion: Potential barriers to achieving regionalization included competition, hospital ownership, population density, and financial challenges. Minimal differences in patient characteristics can establish that patient differences unlikely played any role in influencing earlier or later regionalization and can provide a framework for future analyses evaluating the impact of regionalization on patient outcomes.

  20. Prediction of infarct severity from triiodothyronine levels in patients with ST-elevation myocardial infarction.

    Science.gov (United States)

    Kim, Dong Hun; Choi, Dong-Hyun; Kim, Hyun-Wook; Choi, Seo-Won; Kim, Bo-Bae; Chung, Joong-Wha; Koh, Young-Youp; Chang, Kyong-Sig; Hong, Soon-Pyo

    2014-07-01

    The aim of the present study was to evaluate the relationship between thyroid hormone levels and infarct severity in patients with ST-elevation myocardial infarction (STEMI). We retrospectively reviewed thyroid hormone levels, infarct severity, and the extent of transmurality in 40 STEMI patients evaluated via contrast-enhanced cardiac magnetic resonance imaging. The high triiodothyronine (T3) group (≥ 68.3 ng/dL) exhibited a significantly higher extent of transmural involvement (late transmural enhancement > 75% after administration of gadolinium contrast agent) than did the low T3 group (60% vs. 15%; p = 0.003). However, no significant difference was evident between the high- and low-thyroid-stimulating hormone/free thyroxine (FT4) groups. When the T3 cutoff level was set to 68.3 ng/dL using a receiver operating characteristic curve, the sensitivity was 80% and the specificity 68% in terms of differentiating between those with and without transmural involvement. Upon logistic regression analysis, high T3 level was an independent predictor of transmural involvement after adjustment for the presence of diabetes mellitus (DM) and the use of glycoprotein IIb/IIIa inhibitors (odds ratio, 40.62; 95% confidence interval, 3.29 to 502; p = 0.004). The T3 level predicted transmural involvement that was independent of glycoprotein IIb/IIIa inhibitor use and DM positivity.

  1. Complete Versus Incomplete Angiography Prior to Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction.

    Science.gov (United States)

    Stiver, Kevin; Gao, Xu; Shreenivas, Satya; Boudoulas, Konstantinos Dean; Mazzaferri, Ernie; Makki, Nader; Lilly, Scott M

    2017-08-01

    Shorter reperfusion times in ST-elevation myocardial infarction (STEMI) are associated with improved survival. Prehospital strategies have been developed to minimize door-to-balloon (DTB) time, but few strategies within the catheterization laboratory itself have been evaluated. Incomplete angiography (IA) prior to percutaneous coronary intervention (PCI) is undertaken in clinical practice as a means to further reduce DTB time. We sought to determine whether or not those with STEMI who underwent IA prior to PCI had different preprocedural characteristics or post-PCI outcomes. We retrospectively reviewed patients presenting to our institution between March 2013 and December 2015. Clinical, demographic, and angiographic data were reviewed. The frequency, predictors, and outcomes among those who received IA vs complete angiography (CA) prior to PCI were compared with analysis of variance. Two hundred fifty-six patients were identified; 68 patients (26.6%) underwent IA and 188 patients (73.4%) had CA prior to PCI. Patients who received IA were younger, but no other preprocedural factors were predictive of IA. The practice of IA did vary by operator (range, 0%-47%; P<.01). DTB times were shorter in the IA group (28.1 min vs 37.3 min; P<.01). Overall outcomes, including peak troponin values, length of stay, in-hospital mortality, and discharge ejection fraction did not differ between the groups. IA is associated with shorter DTB times, although in this population was not associated with improvements in short-term outcomes.

  2. Factors Associated With Ineligibility for PCI Differ Between Inpatient and Outpatient ST-Elevation Myocardial Infarction.

    Science.gov (United States)

    Jaski, Brian E; Grigoriadis, Christopher E; Dai, Xuming; Meredith, Richard D; Ortiz, Bryan C; Stouffer, George A; Thomas, Lorie; Smith, Sidney C

    2016-08-01

    Without early revascularization, both inpatient and outpatient STEMIs have poor outcomes. Reasons for denying PCI for STEMI, however, remain uncertain. This single-center retrospective cohort study compares factors and outcomes associated with ineligibility for PCI between inpatients and outpatients following ST-elevation myocardial infarction (STEMI). A total of 1,759 STEMI patients between June 2009 and January 2015 were assessed. Individual medical records were reviewed to obtain reasons for PCI ineligibility for STEMI patients who did not receive reperfusion therapy. Compared to outpatients with STEMI (n = 1,688), inpatients (n = 71) were less likely to receive coronary angiography (60.6% vs 95.9%; P PCI (50.7% vs 80.9%; P PCI and procedural success were seen in both groups. Principal contraindication for PCI was risk of bleeding within the inpatient population and complex coronary artery disease within the outpatient population. Total in-hospital mortality was higher in inpatient STEMIs compared to outpatients (42.2% vs 10.0%; P PCI in both groups. Reasons for PCI ineligibility differ between inpatient and outpatient STEMIs. Inpatients have increased risks of bleeding, lower coronary angiography and PCI use, and higher in-hospital mortality. Especially for inpatients, specific PCI STEMI protocols that anticipate and overcome types of ineligibility and delay for cardiac catheterization may improve outcomes. © 2016, Wiley Periodicals, Inc.

  3. The role of SCUBE1 in the development of late stent thrombosis presenting with ST-elevation myocardial infarction.

    Science.gov (United States)

    Bolayır, Hasan Ata; Kıvrak, Tarık; Güneş, Hakan; Akaslan, Dursun; Şahin, Ömer; Bolayır, Aslı

    2018-05-01

    There is an important link between platelets and inflammation, thrombosis, and vascular and tissue repair mechanisms. SCUBE1 (signal peptide-CUB-EGF domain-containing protein 1) may function as a novel platelet-endothelial adhesion molecule and play pathological roles in cardiovascular biology. Stent thrombosis (ST) following percutaneous coronary intervention is an uncommon and potentially catastrophic event that can manifest as myocardial infarction and sudden death. High platelet reactivity is a risk factor for thrombotic events, including late ST. For this reason, in the current study, we researched the role of SCUBE1 in the development of late coronary ST. We included 40 patients admitted to our hospital with a diagnosis of ST-elevation myocardial infarction (STEMI) and signs of late ST on a coronary angiogram. For the control group, we recruited 50 healthy gender- and age-matched individuals who were seen for health check-ups. We also randomly included 100 patients with a diagnosis of STEMI without ST. There were no significant differences between the groups in terms of baseline and demographic characteristics. The mean SCUBE1 level in patients with STEMI with late ST at admission and the STEMI without ST group was significantly higher than in the control group (pST group was significantly higher than in the STEMI without ST group (p=0.03). In multivariate regression analysis, serum SCUBE1 (odds ratio [OR]: 1.022; 95% confidence interval [CI]: 1.011-1.033, pST. In addition, receiver operating characteristic curve analysis was used to determine the optimal SCUBE1 cut-off value for predicting late ST. The area under the curve was 0.972 (95% CI 0.95-0.98). The SCUBE1 cut-off value was 59.2 ng/ml, with a sensitivity of 95.4% and specificity of 82.9%. The present work is the first clinical study to demonstrate that serum SCUBE1 levels are significantly higher in patients with late ST and serum SCUBE1 was an independent predictor for the presence of late ST in our

  4. 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)....

  5. Left ventricular contractile function after distal protection in primary percutaneous coronary intervention Results from the Drug Elution and Distal Protection in ST-Elevation Myocardial Infarction trial

    DEFF Research Database (Denmark)

    Kofoed, K F; Kelbæk, H; Thuesen, L

    2011-01-01

    Coronary intervention (PCI) may result in an increased infarct size. We evaluated the effect of distal protection during PCI for ST-segment elevation myocardial infarction (STEMI) on myocardial function.......Coronary intervention (PCI) may result in an increased infarct size. We evaluated the effect of distal protection during PCI for ST-segment elevation myocardial infarction (STEMI) on myocardial function....

  6. Elevated serum angiotensin-converting enzyme (SACE) activity in acute pulmonary histoplasmosis.

    Science.gov (United States)

    Davies, S F; Rohrbach, M S; Thelen, V; Kuritsky, J; Gruninger, R; Simpson, M L; DeRemee, R A

    1984-03-01

    Serum angiotensin-converting enzyme (SACE) levels were measured in 44 subjects six weeks after acute pulmonary histoplasmosis. All patients were infected in a common-source outbreak of histoplasmosis which occurred on one day. All patients had both strictly defined clinical and serologic evidence of infection. The SACE activity was elevated at six weeks compared to normal controls, and seven of the 44 had levels more than 2 SD above the normal mean. SACE levels were also measured at three and 24 weeks after acute infection in a smaller number of the same subjects. Serial observations demonstrated that all subjects (including those with normal and elevated SACE at six weeks) had a rise and fall in SACE activity following symptomatic acute pulmonary histoplasmosis. Our findings suggest that elevated SACE does not reliably separate sarcoidosis from histoplasmosis, although elevations in histoplasmosis are much less common and may occur only briefly following acute pulmonary histoplasmosis. More important, it seems that SACE activity rises acutely in all patients with symptomatic acute histoplasmosis and then falls gradually toward baseline over several months, coinciding temporally with the granulomatous response.

  7. Influence of minor deterioration of renal function after PCI on outcome in patients with ST-elevation myocardial infarction.

    Science.gov (United States)

    Kanic, Vojko; Suran, David; Vollrath, Maja; Tapajner, Alojz; Kompara, Gregor

    2017-10-01

    Our aim was to assess the possible impact of a deterioration of renal function (DRF) not fulfilling the criteria for acute kidney injury after percutaneous coronary intervention (PCI) on outcome in patients with ST-elevation myocardial infarction (STEMI) on 30-day and long-term outcomes. Data is lacking on the influence of DRF after PCI on outcome in patients with STEMI. The present study is an analysis of 2572 STEMI patients who underwent PCI. The group with DRF (1022 patients) and the group without DRF (1550 patients) were compared. Thirty-day and long-term all-cause mortality were observed. Data was analyzed using descriptive statistics. Similar mortality was observed in both groups at day 30 (4.2% patients with DRF died vs 3.2% without DRF; ns) but more patients had died in the DRF group (18.9% patients with DRF vs 14.0% without DRF; P = 0.001) by the end of the observation period. After adjustments, DRF did not independently predict long-term mortality. Age more than 70 years, bleeding, hyperlipidemia, renal dysfunction on admission, anemia on admission, diabetes, PCI of LAD, the use of more than 200 mL contrast, but not DRF after PCI, were identified as independent prognostic factors for increased long-term mortality. Renal dysfunction, bleeding, contrast >200 mL, hyperlipidemia, age >70 years, anemia, and PCI LAD predicted DRF. DRF identified patients at increased risk of higher long-term mortality but was not independently associated with mortality. © 2017, Wiley Periodicals, Inc.

  8. A Study of Platelet Inhibition, Using a 'Point of Care' Platelet Function Test, following Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction [PINPOINT-PPCI].

    Science.gov (United States)

    Johnson, Thomas W; Mumford, Andrew D; Scott, Lauren J; Mundell, Stuart; Butler, Mark; Strange, Julian W; Rogers, Chris A; Reeves, Barnaby C; Baumbach, Andreas

    2015-01-01

    Rapid coronary recanalization following ST-elevation myocardial infarction (STEMI) requires effective anti-platelet and anti-thrombotic therapies. This study tested the impact of door to end of procedure ('door-to-end') time and baseline platelet activity on platelet inhibition within 24hours post-STEMI. 108 patients, treated with prasugrel and procedural bivalirudin, underwent Multiplate® platelet function testing at baseline, 0, 1, 2 and 24hours post-procedure. Major adverse cardiac events (MACE), bleeding and stent thrombosis (ST) were recorded. Baseline ADP activity was high (88.3U [71.8-109.0]), procedural time and consequently bivalirudin infusion duration were short (median door-to-end time 55minutes [40-70] and infusion duration 30minutes [20-42]). Baseline ADP was observed to influence all subsequent measurements of ADP activity, whereas door-to-end time only influenced ADP immediately post-procedure. High residual platelet reactivity (HRPR ADP>46.8U) was observed in 75% of patients immediately post-procedure and persisted in 24% of patients at 2hours. Five patients suffered in-hospital MACE (4.6%). Acute ST occurred in 4 patients, all were <120mins post-procedure and had HRPR. No significant bleeding was observed. In a post-hoc analysis, pre-procedural morphine use was associated with significantly higher ADP activity following intervention. Baseline platelet function, time to STEMI treatment and opiate use all significantly influence immediate post-procedural platelet activity.

  9. Impact of admission blood glucose levels on prognosis of elderly patients with ST elevation myocardial infarction treated by primary percutaneous coronary intervention

    Science.gov (United States)

    Ekmekci, Ahmet; Uluganyan, Mahmut; Tufan, Fatif; Uyarel, Huseyin; Karaca, Gurkan; Kul, Seref; Gungor, Barış; Ertas, Gokhan; Erer, Betul; Sayar, Nurten; Gul, Mehmet; Eren, Mehmet

    2013-01-01

    Objective Admission hyperglycemia in acute myocardial infarction (MI) is related with increased in-hospital and long term mortality and major cardiac adverse events. We aimed to investigate how admission hyperglycemia affects the short and long term outcomes in elderly patients (> 65 years) after primary percutaneous coronary intervention for ST elevation myocardial infarction. Methods We retrospectively analyzed 677 consecutive elderly patients (mean age 72.2 ± 5.4). Patients were divided into two groups according to admission blood glucose levels. Group 1: low glucose group (LLG), glucose 168 mg/dL. Results In-hospital, long term mortality and in-hospital major adverse cardiac events were higher in the high admission blood glucose group (P 1, post-thrombolysis in MI < 3 and admission blood glucose levels were independent predictors of in-hospital adverse cardiac events (P < 0.001). Conclusions Admission hyperglycemia in elderly patients presented with ST elevation myocardial infarction is an independent predictor of in-hospital major adverse cardiac events and is associated with in-hospital and long term mortality. PMID:24454322

  10. In-hospital outcome in patients with ST elevation myocardial infarction and right bundle branch block. A sub-study from RENASICA II, a national multicenter registry.

    Science.gov (United States)

    Juárez-Herrera, Ursulo; Jerjes Sánchez, Carlos; González-Pacheco, Héctor; Martínez-Sánchez, Carlos

    2010-01-01

    Compare in-hospital outcome in patients with ST-elevation myocardial infarction with right versus left bundle branch block. RENASICA II, a national Mexican registry enrolled 8098 patients with final diagnosis of acute coronary syndrome secondary to ischemic heart disease. In 4555 STEMI patients, 545 had bundle branch block, 318 (58.3%) with right and 225 patients with left (41.6%). Both groups were compared in terms of in-hospital outcome through major cardiovascular adverse events; (cardiovascular death, recurrent ischemia and reinfarction). Multivariable analysis was performed to identify in-hospital mortality risk among right and left bundle branch block patients. There were not statistical differences in both groups regarding baseline characteristics, time of ischemia, myocardial infarction location, ventricular dysfunction and reperfusion strategies. In-hospital outcome in bundle branch block group was characterized by a high incidence of major cardiovascular adverse events with a trend to higher mortality in patients with right bundle branch block (OR 1.70, CI 1.19 - 2.42, p right bundle branch block accompanying ST-elevation myocardial infarction of any location at emergency room presentation was an independent predictor of high in-hospital mortality.

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    The long-term risk associated with different coronary artery disease (CAD) presentations in women undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is poorly characterized. We pooled patient-level data for women enrolled in 26 randomized clinical trials. Of 11......,577 women included in the pooled database, 10,133 with known clinical presentation received a DES. Of them, 5,760 (57%) had stable angina pectoris (SAP), 3,594 (35%) had unstable angina pectoris (UAP) or non-ST-segment-elevation myocardial infarction (NSTEMI), and 779 (8%) had ST......-segment-elevation myocardial infarction (STEMI) as clinical presentation. A stepwise increase in 3-year crude cumulative mortality was observed in the transition from SAP to STEMI (4.9% vs 6.1% vs 9.4%; p clinical...

  12. Association of elevated serum cardiac troponin-I level and complications in acute heart failurecases

    Directory of Open Access Journals (Sweden)

    Farjana Akhter

    2013-07-01

    Full Text Available Acute heart failure is one of the major causes of morbidity and mortality all over the world. Available published data has suggested that patients of acute heart failure with elevated level of serum cardiac troponin-I (cTn-I have more adverse outcomes than that of acute heart failure with normal cTn-I level. Elevated level of serum cTn-I is a potential risk factor for acute heart failure. This study was carried out in the department of Biochemistry, Dhaka Medical College and National Institute of Cardiovascular Disease (NICVD during the period from January 2010 to December 2010. In this study, 100 patients with acute heart failure were enrolled. Out of 100 cases, 50 had elevated serum cTn-I (cTn-I ³ 1.0 ng/ml and 50 had normal serum cTn-I (cTn-I < 1.0 ng/ml. The adverse outcome of the two groups were recorded and compared. Patients with high and normal serum cTn-I had mean age of 52.40 ± 8.10 years and 54.64 ± 7.26 years respectively while male and female cases were equally distributed. Left ventricular systolic dysfunction (lower ejection fraction was significantly (p<0.05 higher among cases with elevated cTn-I level compared to those with normal level. The rate of renal failure (raised serum creatinine, impaired liver functions (raised ALT and AST and abnormal serum electrolytes were significantly higher among the patients with elevated cTn-I compared to those with normal level. The study showed that elevated serum cTn-I level was a good biomarker to indicate adverse complications in acute heart failure cases. Ibrahim Med. Coll. J. 2013; 7(2: 32-34

  13. Acute Alcohol Consumption Elevates Serum Bilirubin, an Endogenous Antioxidant

    Science.gov (United States)

    O’Malley, Stephanie S.; Gueorguieva, Ralitza; Wu, Ran; Jatlow, Peter I.

    2015-01-01

    Background Moderate alcohol consumption has been associated with both negative and favorable effects on health. The mechanisms responsible for reported favorable effects remain unclear. Higher (not necessarily elevated) concentrations of serum bilirubin, an antioxidant, have also been associated with reduced risk of cardiovascular disease and all-cause mortality. This study tests the hypothesis that single dose alcohol consumption elevates bilirubin providing a potential link between these observations. Methods 18 healthy individuals (8 cigarette smokers) were administered alcohol, calibrated to achieve blood concentrations of 20, 80 and 120 mg/dL, in random order in 3 laboratory sessions separated by a week. Each session was preceded by and followed by 5–7 days of alcohol abstinence. Serum bilirubin was measured at 7:45 am prior to drinking, at 2 pm, and at 7:45 the next morning. Mixed effects regression models compared baseline and 24 hr. post-drinking bilirubin concentrations. Results Total serum bilirubin (sum of indirect and direct) concentration increased significantly after drinking from baseline to 24 hours in non-smokers (from Mean=0.38, SD=0.24 to Mean=0.51 SD=0.30, F(1, 32.2) =24.24, pbilirubin concentration and the ratio of indirect (unconjugated) to direct (conjugated) bilirubin also increased significantly. Conclusions Alcohol consumption leads to increases in serum bilirubin in nonsmokers. Considering the antioxidant properties of bilirubin, our findings suggest one possible mechanism for the reported association between alcohol consumption and reduced risk of some disorders that could be tested in future longitudinal studies. PMID:25707709

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

    International Nuclear Information System (INIS)

    Hussain, S.; Kayani, A. M.; Munir, R.

    2014-01-01

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

  15. 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: The EUROMAX ST-segment resolution substudy.

    Science.gov (United States)

    Van't Hof, Arnoud; Giannini, Francesco; Ten Berg, Jurrien; Tolsma, Rudolf; Clemmensen, Peter; Bernstein, Debra; Coste, Pierre; Goldstein, Patrick; Zeymer, Uwe; Hamm, Christian; Deliargyris, Efthymios; Steg, Philippe G

    2017-08-01

    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 or enoxaparin with or without GPIIb/IIIa inhibitors (GPIs) in primary PCI. This nested substudy was performed in centres routinely using pre-hospital GPI in order to compare the impact of randomized treatments on ST-resolution after primary PCI. Residual cumulative ST-segment deviation on the single one hour post-procedure electrocardiogram (ECG) was assessed by an independent core laboratory and was the primary endpoint. It was calculated that 762 evaluable patients were needed to show non-inferiority (85% power, alpha 2.5%) between randomized treatments. A total of 871 participated 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. 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.

  16. Significantly Elevated Serum Lipase in Pregnancy with Nausea and Vomiting: Acute Pancreatitis or Hyperemesis Gravidarum?

    Directory of Open Access Journals (Sweden)

    Amanda Johnson

    2015-01-01

    Full Text Available Hyperemesis gravidarum is a severe manifestation of nausea and vomiting of pregnancy and it is associated with weight loss and metabolic abnormalities. It is known that abnormal laboratory values, including mildly elevated serum lipase level, could be associated with hyperemesis gravidarum. However, in this case report details of two women with hyperemesis gravidarum but with significantly elevated serum lipase levels were discussed. These patients presented with severe nausea and vomiting but without abdominal pain. They were found to have severely elevated lipase levels over 1,000 units/liter. In the absence of other findings of pancreatitis, they were treated with conservative measures for hyperemesis gravidarum, with eventual resolution to normal lipase levels. Although significantly elevated lipase level in pregnant patients with nausea and vomiting is a concern for acute pancreatitis, these two cases of significantly elevated serum lipase without other clinical findings of pancreatitis led to this report that serum lipase could be quite elevated in hyperemesis gravidarum and that it might not be an accurate biochemical marker for acute pancreatitis. Imaging studies are thus necessary to establish the diagnosis of acute pancreatitis.

  17. One-year Outcomes in Patients with ST-segment Elevation Myocardial Infarction Caused by Unprotected Left Main Coronary Artery Occlusion Treated by Primary Percutaneous Coronary Intervention.

    Science.gov (United States)

    Liu, Hai-Wei; Han, Ya-Ling; Jin, Quan-Min; Wang, Xiao-Zeng; Ma, Ying-Yan; Wang, Geng; Wang, Bin; Xu, Kai; Li, Yi; Chen, Shao-Liang

    2018-06-20

    Very few data have been reported for ST-segment elevation myocardial infarction (STEMI) caused by unprotected left main coronary artery (ULMCA) occlusion, and very little is known about the results of this subgroup of patients who underwent primary percutaneous coronary intervention (PCI). The aim of this study was to determine the clinical features and outcomes of patients with STEMI who underwent primary PCI for acute ULMCA occlusion. From January 2000 to February 2014, 372 patients with STEMI caused by ULMCA acute occlusion (ULMCA-STEMI) who underwent primary PCI at one of two centers were enrolled. The 230 patients with non-ST-segment elevation MI (NSTEMI) caused by ULMCA lesion (ULMCA-NSTEMI) who underwent emergency PCI were designated the control group. The main indexes were the major adverse cardiac events (MACEs) in-hospital, at 1 month, and at 1 year. Compared to the NSTEMI patients, the patients with STEMI had significantly higher rates of Killip class≥III (21.2% vs. 3.5%, χ 2 = 36.253, P 0.05) and TVR (all P > 0.05) in the intervals of 0-1 month as well as 1 month to 1 year. The results of Cox regression analysis showed that the differences in the independent predictors for MACE included the variables of Killip class ≥ III and intra-aortic balloon pump support for the STEMI patients and the variables of previous MI, ULMCA distal bifurcation, and 2-stent for distal ULMCA lesions for the NSTEMI patients. Compared to the NSTEMI patients, the patients with STEMI and ULMCA lesions still remain at a much higher risk for adverse events at 1 year, especially on 1 month. If a successful PCI procedure is performed, the 1-year outcomes in those patients might improve.

  18. 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

    BACKGROUND: ST-segment depression and T-wave inversion (ST-T changes) in the electrocardiogram (ECG) and raised levels of natriuretic peptide have been observed in acute ischemic stroke patients. It is unknown whether any relation between ST-T changes and raised levels of natriuretic peptides...... 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...

  19. Smokers with ST-segment elevation myocardial infarction and short time to treatment have equal effects of PCI and fibrinolysis

    DEFF Research Database (Denmark)

    Rasmussen, Thomas; Kelbæk, Henning Skov; Madsen, Jan Kyst

    2012-01-01

    The purpose of this study was to examine the effect of primary percutaneous coronary intervention (PCI) compared to fibrinolysis in smokers and non-smokers with ST-segment elevation myocardial infarction (STEMI). Smokers seem to have less atherosclerosis but are more prone to thrombotic disease....... Compared to non-smokers, they have higher rates of early, complete reperfusion when treated with fibrinolysis for MI....

  20. Ticagrelor versus clopidogrel in real-world patients with ST elevation myocardial infarction: 1-year results by propensity score analysis

    OpenAIRE

    Vercellino, Matteo; S?nchez, Federico Ariel; Boasi, Valentina; Perri, Dino; Tacchi, Chiara; Secco, Gioel Gabrio; Cattunar, Stefano; Pistis, Gianfranco; Mascelli, Giovanni

    2017-01-01

    Background European guidelines recommend the use of ticagrelor versus clopidogrel in patients with ST elevation myocardial infarction (STEMI). This recommendation is based on inconclusive results and subanalyses from clinical trials. Few data are available on the effects of ticagrelor in a real-world population. Methods To compare the effects of ticagrelor and clopidogrel in a real-world STEMI population, we conducted a pre-post case-control study examining all patients with STEMI included in...

  1. 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...... sparsely investigated. The objective of this study was to assess the incidence, predictors and prognostic significance of HAVB in STEMI patients treated with pPCI....

  2. Elevation of Serum Acid Sphingomyelinase Activity in Children with Acute Respiratory Syncytial Virus Bronchiolitis.

    Science.gov (United States)

    Yoshida, Shuichiro; Noguchi, Atsuko; Kikuchi, Wataru; Fukaya, Hiroshi; Igarashi, Kiyoshi; Takahashi, Tsutomu

    2017-12-01

    Acid sphingomyelinase (ASM) is a lysosomal enzyme that hydrolyzes sphingomyelin into ceramide, a bioactive lipid to regulate cellular physiological functions. Thus, ASM activation has been reported as a key event in pathophysiological reactions including inflammation, cytokine release, oxidative stress, and endothelial damage in human diseases. Since ASM activation is associated with extracellular ASM secretion through unknown mechanisms, it can be detected by recognizing the elevation of secretory ASM (S-ASM) activity. Serum S-ASM activity has been reported to increase in chronic diseases, acute cardiac diseases, and systemic inflammatory diseases. However, the serum S-ASM has not been investigated in common acute illness. This study was designed to evaluate serum S-ASM activity in children with common acute illness. Fifty children with common acute illness and five healthy children were included in this study. The patients were categorized into five groups based on clinical diagnoses: acute respiratory syncytial virus (RSV) bronchiolitis, adenovirus infection, streptococcal infection, asthma, and other infections due to unknown origin. The serum S-ASM activity was significantly elevated at 6.9 ± 1.6 nmol/0.1 mL/6 h in the group of acute RSV bronchiolitis patients compared with healthy children who had a mean level of 1.8 ± 0.8 nmol/0.1 mL/6 h (p ASM activity was not significantly elevated. The results suggest an association of ASM activation with RSV infection, a cause for common acute illness. This is the first report to describe the elevation of serum S-ASM activity in respiratory tract infection.

  3. Prevalence and significance of troponin elevations in patients without acute coronary disease

    DEFF Research Database (Denmark)

    Vestergaard, Kirstine Roll; Jespersen, Camilla Bang; Arnadottir, Asthildur

    2016-01-01

    BACKGROUND: Cardiac troponin T and I are important diagnostic and prognostic markers in patients with acute coronary syndrome (ACS). Troponin elevations in various non-ACS scenarios have been documented, but few studies have been conducted on the general hospitalized population, none compared...

  4. Immune responses of eastern fence lizards (Sceloporus undulatus) to repeated acute elevation of corticosterone.

    Science.gov (United States)

    McCormick, Gail L; Langkilde, Tracy

    2014-08-01

    Prolonged elevations of glucocorticoids due to long-duration (chronic) stress can suppress immune function. It is unclear, however, how natural stressors that result in repeated short-duration (acute) stress, such as frequent agonistic social encounters or predator attacks, fit into our current understanding of the immune consequences of stress. Since these types of stressors may activate the immune system due to increased risk of injury, immune suppression may be reduced at sites where individuals are repeatedly exposed to potentially damaging stressors. We tested whether repeated acute elevation of corticosterone (CORT, a glucocorticoid) suppresses immune function in eastern fence lizards (Sceloporus undulatus), and whether this effect varies between lizards from high-stress (high baseline CORT, invaded by predatory fire ants) and low-stress (low baseline CORT, uninvaded) sites. Lizards treated daily with exogenous CORT showed higher hemagglutination of novel proteins by their plasma (a test of constitutive humoral immunity) than control lizards, a pattern that was consistent across sites. There was no significant effect of CORT treatment on bacterial killing ability of plasma. These results suggest that repeated elevations of CORT, which are common in nature, produce immune effects more typical of those expected at the acute end of the acute-chronic spectrum and provide no evidence of modulated consequences of elevated CORT in animals from high-stress sites. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Sgarbossa criteria and acute myocardial infarction.

    Science.gov (United States)

    Alang, Neha; Bathina, Jaya; Kranis, Mark; Angelis, Dimitrios

    2010-01-01

    Diagnosis of acute ST-elevation myocardial infarction in the presence of left bundle branch block is difficult. present a case of acute myocardial infarction with LBBB diagnosed and treated using the Sgarbossa criteria.

  6. Frequency and significance of troponin T elevation in acute ischemic stroke

    DEFF Research Database (Denmark)

    Jensen, Jesper K.; Kristensen, Søren R.; Bak, Søren

    2007-01-01

    Elevated levels of troponin have been reported in patients with acute ischemic stroke. In this prospective study, the prevalence and characteristics of troponin elevation were examined in 244 patients with acute ischemic stroke but without overt ischemic heart disease. Troponin T (TnT) and creatine...... for a mean of 19 +/- 7 months, with all-cause mortality as the clinical end point. Elevated levels of TnT (>0.03 micro g/L) and creatine kinase-MB (> or =10 micro g/L) were observed in 10% and 9% of patients, respectively. Patients with elevated TnT had higher frequencies of heart and/or renal failure....... Perfusion abnormalities on myocardial perfusion scintigraphy at rest were not more frequent or pronounced in patients with TnT levels of > or =0.10 micro g/L than in the control group. Only 7 patients (3%) had elevations of TnT or creatine kinase-MB and electrocardiographic changes suggesting acute...

  7. Acute coronary syndrome

    Science.gov (United States)

    ... Have plenty of fruits, veggies, whole grains, and lean meats. Try to limit foods high in cholesterol ... et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary ...

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

    Science.gov (United States)

    2012-01-01

    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 distance up to 150 km

  9. ST segment elevation in lead aVR during exercise testing is associated with LAD stenosis

    International Nuclear Information System (INIS)

    Neill, Johanne; Harbinson, Mark; Shannon, Heather J.; Morton, Amanda; Muir, Alison R.; Adgey, Jennifer A.

    2007-01-01

    To evaluate, in patients with chest pain, the diagnostic value of ST elevation (STE) in lead aVR during stress testing prior to 99m Tc-sestamibi scanning correlating ischaemic territory with angiographic findings. Consecutive patients attending for 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.)

  10. CAN TIMI RISK SCORE PREDICT ANGIOGRAPHIC INVOLVEMENT IN PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION?

    Directory of Open Access Journals (Sweden)

    Allahyar Golabchi

    2010-11-01

    Full Text Available BACKGROUND: In most studies, the agreeable risk scores for ST-elevation myocardial infarction (STEMI consist of thrombolytic in myocardial infarction (TIMI risk score and modified Gensini risk score. Researchers showed significant relations between TIMI with angiography scores in patients with UA/NSTEMI. We studied this relation in patients with STEMI.    METHODS: We studied CCU patients with STEMI hospitalized in several hospitals of Isfahan, Iran from September 2007 to June 2008. Sampling method of 240 patients was random and simple. Exclusion criteria were incomplete history, nonspecific electrocardiogram changes, left bundle branch block and not accomplished angiography or accomplished angiography after 2 months of STEMI. Questionnaire indices collected on the basis of TIMI (0-14 points. Echocardiography and angiography were done and then, we used Gensini (0-400 points to review films of angiography. Spearman`s rank test and Pearson correlation coefficient were used to study the relation between these scores.    RESULTS: One hundred and sixty one patients were male and their average age was 60.02 years. Averages of TIMI and Gensini scores were 6.30 ± 2.5 and 120.77 ± 50.4, respectively. Study showed significant relation between TIMI, age and LVEF (P <0.001, r=-0.46. Also, between Gensini and age, gender and LVEF significant relation was found (P <0.001. But, a meaningful correlation didn’t exist between TIMI and the gender (P =0.08. Our study proved direct relation between TIMI risk scores and modified Gensini scores (P <0.001, r=0.55.     CONCLUSION: We may decide quickly and correctly in emergency room to distinguish which patients with STEMI could derive a benefit from invasive strategies using TIMI score. Also, TIMI risk score can be a good predictor to determine the extension of coronary artery disease in patients with STEMI. As a result, we suggest determination of TIMI score for any patient entered emergency room. Also

  11. Statin Eligibility and Outpatient Care Prior to ST-Segment Elevation Myocardial Infarction.

    Science.gov (United States)

    Miedema, Michael D; Garberich, Ross F; Schnaidt, Lucas J; Peterson, Erin; Strauss, Craig; Sharkey, Scott; Knickelbine, Thomas; Newell, Marc C; Henry, Timothy D

    2017-04-12

    The impact of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines on statin eligibility in individuals otherwise destined to experience cardiovascular disease (CVD) events is unclear. We analyzed a prospective cohort of consecutive ST-segment elevation myocardial infarction (STEMI) patients from a regional STEMI system with data on patient demographics, low-density lipoprotein cholesterol levels, CVD risk factors, medication use, and outpatient visits over the 2 years prior to STEMI. We determined pre-STEMI eligibility according to American College of Cardiology/American Heart Association guidelines and the prior Third Report of the Adult Treatment Panel guidelines. Our sample included 1062 patients with a mean age of 63.7 (13.0) years (72.5% male), and 761 (71.7%) did not have known CVD prior to STEMI. Only 62.5% and 19.3% of individuals with and without prior CVD were taking a statin before STEMI, respectively. In individuals not taking a statin, median (interquartile range) low-density lipoprotein cholesterol levels in those with and without known CVD were low (108 [83, 138]  mg/dL and 110 [87, 133] mg/dL). For individuals not taking a statin, only 38.7% were statin eligible by ATP III guidelines. Conversely, 79.0% would have been statin eligible according to American College of Cardiology/American Heart Association guidelines. Less than half of individuals with (49.2%) and without (41.1%) prior CVD had seen a primary care provider during the 2 years prior to STEMI. In a large cohort of STEMI patients, application of American College of Cardiology/American Heart Association guidelines more than doubled pre-STEMI statin eligibility compared with Third Report of the Adult Treatment Panel guidelines. However, access to and utilization of health care, a necessity for guideline implementation, was suboptimal prior to STEMI. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  12. Excess mortality and guideline-indicated care following non-ST-elevation myocardial infarction.

    Science.gov (United States)

    Dondo, Tatendashe B; Hall, Marlous; Timmis, Adam D; Gilthorpe, Mark S; Alabas, Oras A; Batin, Phillip D; Deanfield, John E; Hemingway, Harry; Gale, Chris P

    2017-08-01

    Adherence to guideline-indicated care for the treatment of non-ST-elevation myocardial infarction (NSTEMI) is associated with improved outcomes. We investigated the extent and consequences of non-adherence to guideline-indicated care across a national health system. A cohort study ( ClinicalTrials.gov identifier: NCT02436187) was conducted using data from the Myocardial Ischaemia National Audit Project ( n = 389,057 NSTEMI, n = 247 hospitals, England and Wales, 2003-2013). Accelerated failure time models were used to quantify the impact of non-adherence on survival according to dates of guideline publication. Over a period of 1,079,044 person-years (median 2.2 years of follow-up), 113,586 (29.2%) NSTEMI patients died. Of those eligible to receive care, 337,881 (86.9%) did not receive one or more guideline-indicated intervention; the most frequently missed were dietary advice ( n = 254,869, 68.1%), smoking cessation advice ( n = 245,357, 87.9%), P2Y12 inhibitors ( n = 192,906, 66.3%) and coronary angiography ( n = 161,853, 43.4%). Missed interventions with the strongest impact on reduced survival were coronary angiography (time ratio: 0.18, 95% confidence interval (CI): 0.17-0.18), cardiac rehabilitation (time ratio: 0.49, 95% CI: 0.48-0.50), smoking cessation advice (time ratio: 0.53, 95% CI: 0.51-0.57) and statins (time ratio: 0.56, 95% CI: 0.55-0.58). If all eligible patients in the study had received optimal care at the time of guideline publication, then 32,765 (28.9%) deaths (95% CI: 30,531-33,509) may have been prevented. The majority of patients hospitalised with NSTEMI missed at least one guideline-indicated intervention for which they were eligible. This was significantly associated with excess mortality. Greater attention to the provision of guideline-indicated care for the management of NSTEMI will reduce premature cardiovascular deaths.

  13. 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...

  14. Effect of oxygen therapy on chest pain in patients with ST elevation myocardial infarction: results from the randomized SOCCER trial.

    Science.gov (United States)

    Khoshnood, Ardavan; Akbarzadeh, Mahin; Carlsson, Marcus; Sparv, David; Bhiladvala, Pallonji; Mokhtari, Arash; Erlinge, David; Ekelund, Ulf

    2018-04-01

    Oxygen (O 2 ) have been a cornerstone in the treatment of acute myocardial infarction. Studies have been inconclusive regarding the cardiovascular and analgesic effects of oxygen in these patients. In the SOCCER trial, we compared the effects of oxygen treatment versus room air in patients with ST-elevation myocardial infarction (STEMI). There was no difference in myocardial salvage index or infarct size assessed with cardiac magnetic resonance imaging. In the present subanalysis, we wanted to evaluate the effect of O 2 on chest pain in patients with STEMI. Normoxic patients with first time STEMI were randomized in the ambulance to standard care with 10 l/min O 2 or room air until the end of the percutaneous coronary intervention (PCI). The ambulance personnel noted the patients´ chest pain on a visual analog scale (VAS; 1-10) before randomization and after the transport but before the start of the PCI, and also registered the amount of morphine given. 160 patients were randomized to O 2 (n = 85) or room air (n = 75). The O 2 group had a higher median VAS at randomization than the air group (7.0 ± 2.3 vs 6.0 ± 2.9; p = .02) and also received a higher median total dose of morphine (5.0 mg ± 4.4 vs 4.0 mg ± 3.7; p = .02). There was no difference between the O 2 and air groups in VAS at the start of the PCI (4.0 ± 2.4 vs 3.0 ± 2.5; p = .05) or in the median VAS decrease from randomization to the start of the PCI (-2.0 ± 2.2 vs -1.0 ± 2.9; p = .18). Taken together with previously published data, these results do not support a significant analgesic effect of oxygen in patients with STEMI. European Clinical Trials Database (EudraCT): 2011-001452-11. ClinicalTrials.gov Identifier: NCT01423929.

  15. Homocysteine enhances the predictive value of the GRACE risk score in patients with ST-elevation myocardial infarction.

    Science.gov (United States)

    Fan, Yan; Wang, Jianjun; Zhang, Sumei; Wan, Zhaofei; Zhou, Dong; Ding, Yanhong; He, Qinli; Xie, Ping

    2017-09-01

    The present study aims to investigate whether the addition of homocysteine level to the Global Registry of Acute Coronary Events (GRACE) risk score enhances its predictive value for clinical outcomes in ST-elevation myocardial infarction (STEMI). A total of 1143 consecutive patients with STEMI were included in this prospective cohort study. Homocysteine was detected, and the GRACE score was calculated. The predictive power of the GRACE score alone or combined with homocysteine was assessed by the receiver operating characteristic (ROC) analysis, methods of net reclassification improvement (NRI) and integrated discrimination improvement (IDI). During a median follow-up period of 36.7 months, 271 (23.7%) patients reached the clinical endpoints. It showed that the GRACE score and homocysteine could independently predict all-cause death [GRACE: HR=1.031 (1.024-1.039), p<0.001; homocysteine: HR=1.023 (1.018-1.028), p<0.001] and MACE [GRACE: HR=1.008 (1.005-1.011), p<0.001; homocysteine: HR=1.022 (1.018-1.025), p<0.001]. When they were used in combination to assess the clinical outcomes, the area under the ROC curve significantly increased from 0.786 to 0.884 (95% CI=0.067-0.128, Z=6.307, p<0.001) for all-cause death and from 0.678 to 0.759 (95% CI=0.055-0.108, Z=5.943, p<0.001) for MACE. The addition of homocysteine to the GRACE model improved NRI (all-cause death: 0.575, p<0.001; MACE: 0.621, p=0.008) and IDI (all-cause death: 0.083, p<0.001; MACE: 0.130, p=0.016), indicating effective discrimination and reclassification. Both the GRACE score and homocysteine are significant and independent predictors for clinical outcomes in patients with STEMI. A combination of them can develop a more predominant prediction for clinical outcomes in these patients.

  16. [Mexican Cardiology Society Guidelines on the management of patients with unstable angina and non-ST-segment elevation myocardial infarction. Cancún, Quintana Roo 15-16 November 2002. Cooperative Group of Consensus].

    Science.gov (United States)

    Lupi-Herrera, Eulo

    2002-01-01

    Mexican Cardiology Society guidelines for the Management of patients with unstable angina and non-ST--segment elevation myocardial infarction are presented. The Mexican Society of Cardiology has engaged in the elaboration of these guidelines in the area of acute coronary syndromes based on the recent report of RENASICA [National Registry of Acute Coronary Syndromes]: 70% of the ACS correspond to patients with unstable angina and non-ST--segment elevation myocardial infarction seen in the emergency departments during the years 1999-2001 in hospitals of 2nd and 3rd level of medical attention. Experts in the subject under consideration were selected to examine subject-specific data and to write guidelines. Special groups were specifically chosen to perform a formal literature review, to weight the strength of evidences for or against a particular treatment or procedure, and to include estimates of expected health outcomes where data exist. Current classifications were used in the recommendations that summarize both the evidence and expert opinion and provide final recommendation for both patient evaluation and therapy. These guidelines represent an attempt to define practices that meet the needs of most patients in most circumstances in Mexico. The ultimate judgment regarding the care of a particular patient must be made by the physician and patient in light of all of the available information and the circumstances presented by that patient. The present guidelines for the management of patients with unstable angina and non-ST--segment elevation myocardial infarction should be reviewed in the next coming future by Mexican cardiologists according to the forthcoming advances in ACS without ST-segment elevation.

  17. 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) trial

    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)....

  18. Plasma Concentration of Biomarkers Reflecting Endothelial Cell- and Glycocalyx Damage are Increased in Patients with Suspected St-Elevation Myocardial Infarction Complicated by Cardiogenic Shock

    DEFF Research Database (Denmark)

    Frydland, Martin; Ostrowski, Sisse Rye; Møller, Jacob Eifer

    2018-01-01

    BACKGROUND: Mortality in ST-elevation myocardial infarction (STEMI)-patients developing cardiogenic shock (CS) during hospitalization is high. Catecholamines, ischemia, and inflammation (parameters present in CS) affect the endothelium. We hypothesized that plasma level of biomarkers reflecting e...

  19. Outcomes after primary percutaneous coronary intervention in octogenarians and nonagenarians with ST segment elevation myocardial infarction from the western denmark heart registry

    DEFF Research Database (Denmark)

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

    2012-01-01

    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...

  20. 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....

  1. Bivalirudin for the treatment of ST-segment elevation myocardial infarction: a NICE single technology appraisal.

    Science.gov (United States)

    Simpson, E L; Fitzgerald, P; Evans, P; Tappenden, P; Kalita, N; Reckless, J P D; Bakhai, A

    2013-04-01

    The National Institute for Health and Clinical Excellence (NICE) invited the manufacturer (The Medicines Company) of bivalirudin to submit evidence for its clinical and cost effectiveness within its licensed indication for the treatment of adults with ST-segment elevation myocardial infarction (STEMI) intended for primary percutaneous coronary intervention (PPCI), as part of NICE's single technology appraisal (STA) process. The School of Health and Related Research (ScHARR) at the University of Sheffield was commissioned to act as the Evidence Review Group (ERG), which produced a review of the evidence within the manufacturer's submission to NICE. This article describes the manufacturer's submission, the ERG review and NICE's subsequent decisions. The main evidence was derived from one randomized controlled trial (RCT) of STEMI patients intended for PPCI, comparing bivalirudin with unfractionated heparin plus glycoprotein IIb/IIIa inhibitors (GPIs). Bivalirudin was associated with a significant reduction in cardiac mortality at 30 days (p = 0.03) and at 1-year follow-up (p = 0.005), and a significant reduction in major bleeding at 30 days (p plus GPI. Stent thrombosis up to 24 hours following PPCI was significantly (p target vessel for ischaemia (p = 0.18 and p = 0.12, respectively). There were two decision-analytic models: the base-case scenario used 1-year follow-up data from the RCT; and a sensitivity analysis used 3-year follow-up data. Resource use was primarily drawn from this RCT. Health-related quality-of-life (HR-QOL) estimates were drawn from a UK cohort study. Both models evaluated the incremental costs and outcomes of bivalirudin compared with heparin plus GPI for patients with STEMI intended for PPCI. The analysis adopted a UK NHS perspective over a lifetime horizon. Unit costs were based on year 2009-2010 prices. The model adopted a decision-tree structure to reflect initial events for the initial period (stroke, repeat MI, minor

  2. Management and Outcomes of ST-Segment Elevation Myocardial Infarction in US Renal Transplant Recipients.

    Science.gov (United States)

    Gupta, Tanush; Kolte, Dhaval; Khera, Sahil; Goel, Kashish; Aronow, Wilbert S; Cooper, Howard A; Jain, Diwakar; Rihal, Charanjit S; Fonarow, Gregg C; Panza, Julio A; Bhatt, Deepak L

    2017-03-01

    Renal transplantation is associated with reduction in the risk for myocardial infarction (MI) in patients with chronic kidney disease requiring long-term dialysis (stage 5D CKD). Whether outcomes of MI differ among renal transplant recipients vs patients with stage 5D CKD or those without CKD has not been well examined. To compare in-hospital reperfusion rates and outcomes of ST-segment elevation MI (STEMI) in renal transplant recipients vs the stage 5D CKD group or the non-CKD group. The National Inpatient Sample database was queried to identify patients 18 years or older who were hospitalized with the principal diagnosis of STEMI. All hospitalizations for STEMI in the United States from January 1, 2003, to December 31, 2013, were included. Codes from International Classification of Diseases, Ninth Revision, Clinical Modification, were used to identify patients in the non-CKD, stage 5D CKD, or prior renal transplant groups. Data were analyzed from March to May 2016. In-hospital mortality. From 2003 to 2013, 2 319 002 patients in the non-CKD group (34.7% women; 65.3% men; mean [SD] age, 64.2 [14.4] years), 30 072 patients in the stage 5D CKD group (45.0% women; 55.0% men; mean [SD] age, 66.9 [12.5] years), and 2980 patients in the renal transplant group (27.3% women; 72.7% men; mean [SD] age, 57.5 [11.1] years) were identified who were hospitalized with STEMI. Of these, 68.9% of the patients in the non-CKD group, 39.5% in the stage 5D CKD group, and 65.2% in the renal transplant group received in-hospital reperfusion for STEMI. The renal transplant group was more likely to receive reperfusion compared with the stage 5D CKD group (adjusted odds ratio [AOR], 1.83; 95% CI, 1.67-2.01; P group (AOR, 0.75; 95% CI, 0.68-0.83; P group with STEMI was markedly lower compared with the stage 5D CKD group (AOR, 0.37; 95% CI, 0.33-0.43; P group (AOR, 1.14; 95% CI, 0.99-1.31; P = .08). Among renal transplant recipients with STEMI, the use of reperfusion increased

  3. A Study of Platelet Inhibition, Using a 'Point of Care' Platelet Function Test, following Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction [PINPOINT-PPCI].

    Directory of Open Access Journals (Sweden)

    Thomas W Johnson

    Full Text Available Rapid coronary recanalization following ST-elevation myocardial infarction (STEMI requires effective anti-platelet and anti-thrombotic therapies. This study tested the impact of door to end of procedure ('door-to-end' time and baseline platelet activity on platelet inhibition within 24hours post-STEMI.108 patients, treated with prasugrel and procedural bivalirudin, underwent Multiplate® platelet function testing at baseline, 0, 1, 2 and 24hours post-procedure. Major adverse cardiac events (MACE, bleeding and stent thrombosis (ST were recorded. Baseline ADP activity was high (88.3U [71.8-109.0], procedural time and consequently bivalirudin infusion duration were short (median door-to-end time 55minutes [40-70] and infusion duration 30minutes [20-42]. Baseline ADP was observed to influence all subsequent measurements of ADP activity, whereas door-to-end time only influenced ADP immediately post-procedure. High residual platelet reactivity (HRPR ADP>46.8U was observed in 75% of patients immediately post-procedure and persisted in 24% of patients at 2hours. Five patients suffered in-hospital MACE (4.6%. Acute ST occurred in 4 patients, all were <120mins post-procedure and had HRPR. No significant bleeding was observed. In a post-hoc analysis, pre-procedural morphine use was associated with significantly higher ADP activity following intervention.Baseline platelet function, time to STEMI treatment and opiate use all significantly influence immediate post-procedural platelet activity.

  4. St George Acute Care Team: the local variant of crisis resolution model of care.

    Science.gov (United States)

    Cupina, Denise D; Wand, Anne P F; Phelan, Emma; Atkin, Rona

    2016-10-01

    The objective of this study was to describe functioning and clinical activities of the St George Acute Care Team and how it compares to the typical crisis resolution model of care. Descriptive data including demographics, sources of referral, type of clinical intervention, length of stay, diagnoses and outcomes were collected from records of all patients who were discharged from the team during a 10 week period. There were 677 referrals. The team's functions consisted of post-discharge follow-up (31%), triage and intake (30%), case management support (23%) and acute community based assessment and treatment (16%). The average length of stay was 5 days. The majority of patients were diagnosed with a mood (23%) or a psychotic (25%) disorder. Points of contrast to other reported crisis resolution teams include shorter length of stay, relatively less focus on direct clinical assessment and more telephone follow-up and triage. St George Acute Care Team provides a variety of clinical activities. The focus has shifted away from the original model of crisis resolution care to meet local and governmental requirements. © The Royal Australian and New Zealand College of Psychiatrists 2016.

  5. 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...... compared to intravenous abciximab (4.7% vs. 8.8%; rate ratio [RR], 0.50; 95% confidence intervals [CI], 0.26-0.99; p=0.04), driven by numerically lower deaths (3.7% vs. 6.4%; RR, 0.56; 95% CI, 0.26-1.20; p=0.13). Moreover, a significant reduction in definite or probable stent thrombosis was observed...

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

    Science.gov (United States)

    Khot, Umesh N; Johnson-Wood, Michele L; Geddes, Jason B; Ramsey, Curtis; Khot, Monica B; Taillon, Heather; Todd, Randall; Shaikh, Saeed R; Berg, William J

    2009-07-26

    The impact of reducing door-to-balloon time on hospital revenues, costs, and net income is unknown. 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. 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. All of the financial benefits of reducing door-to-balloon time in ST-elevation myocardial

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

    Science.gov (United States)

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

    2015-09-15

    The long-term risk associated with different coronary artery disease (CAD) presentations in women undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is poorly characterized. We pooled patient-level data for women enrolled in 26 randomized clinical trials. Of 11,577 women included in the pooled database, 10,133 with known clinical presentation received a DES. Of them, 5,760 (57%) had stable angina pectoris (SAP), 3,594 (35%) had unstable angina pectoris (UAP) or non-ST-segment-elevation myocardial infarction (NSTEMI), and 779 (8%) had ST-segment-elevation myocardial infarction (STEMI) as clinical presentation. A stepwise increase in 3-year crude cumulative mortality was observed in the transition from SAP to STEMI (4.9% vs 6.1% vs 9.4%; p clinical presentations. After multivariable adjustment, STEMI was independently associated with greater risk of 3-year mortality (hazard ratio [HR] 3.45; 95% confidence interval [CI] 1.99 to 5.98; p clinical spectrum of CAD, STEMI was associated with a greater risk of long-term mortality. Conversely, the adjusted risk of mortality between UAP or NSTEMI and SAP was similar. New-generation DESs provide improved long-term clinical outcomes irrespective of the clinical presentation in women. Published by Elsevier Inc.

  8. 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

  9. Fractalkine levels are elevated early after PCI-treated ST-elevation myocardial infarction; no influence of autologous bone marrow derived stem cell injection.

    Science.gov (United States)

    Njerve, Ida Unhammer; Solheim, Svein; Lunde, Ketil; Hoffmann, Pavel; Arnesen, Harald; Seljeflot, Ingebjørg

    2014-09-01

    Fractalkine (CX3CL1) is a chemokine associated with atherosclerosis and inflammation. There is limited knowledge of fractalkine levels during acute myocardial infarction (AMI) and stem cell treatment. We aimed to investigate the time profile of circulating fractalkine and gene expression of its receptor CX3CR1 during AMI, and the influence of intracoronary autologous bone marrow stem cell (mBMC) transplantation (given 6 days after AMI) on fractalkine levels. We examined fractalkine levels at different time points by enzyme-linked immunosorbent assay (ELISA) in 20 patients with AMI, and 10 patients with stable angina pectoris (AP) undergoing percutaneous coronary intervention (PCI), and in 100 patients included in the randomized Autologous Stem-Cell Transplantation in Acute Myocardial Infarction (ASTAMI) trial. Patients with AMI had significantly elevated levels 3- and 12 h after PCI compared to patients with stable AP. After 12 h levels were similar in the two groups. An inverse pattern was observed in gene expression levels. No correlation between fractalkine levels and myocardial injury or infarct size was seen. We could not demonstrate any influence of autologous mBMC transplantation on fractalkine levels. Fractalkine levels are elevated the first 12 h after PCI in patients with AMI, however, not correlated to infarct size. The inverse pattern in gene expression of fractalkine receptor (CX3CR1) might be a compensatory mechanism. No effect of autologous mBMC transplantation given 6 days after AMI on fractalkine levels was observed. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. 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...

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

    International Nuclear Information System (INIS)

    Gibson, R.S.; Crampton, R.S.; Watson, D.D.; Taylor, G.J.; Carabello, B.A.; Holt, N.D.; Beller, G.A.

    1982-01-01

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

  12. Role of optical coherence tomography in managing patients with ST elevation myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Shah, Ashish; Ing, Douglas J., E-mail: douglas.ing@uhn.ca

    2017-03-15

    Stenting the culprit lesion in patients presenting with acute coronary syndrome (ACS) is the standard of care. Although plaque rupture on an atheromatous lesion is the most common underlying pathology, other mechanisms can also result in ACS presentation; some of which can be managed without stenting. Here we describe a case that was managed conservatively, after evaluating plaque erosion as the underlying mechanism and lack of obstructive lesion. This case highlights the importance of intracoronary imaging to assess the underlying mechanism in patients presenting with acute coronary syndrome.

  13. Predictive values of D-dimer assay, GRACE scores and TIMI scores for adverse outcome in patients with non-ST-segment elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Satilmisoglu MH

    2017-03-01

    Full Text Available Muhammet Hulusi Satilmisoglu,1 Sinem Ozbay Ozyilmaz,1 Mehmet Gul,1 Hayriye Ak Yildirim,2 Osman Kayapinar,3 Kadir Gokturk,4 Huseyin Aksu,1 Korhan Erkanli,5 Abdurrahman Eksik1 1Department of Cardiology, 2Department of Biochemistry, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, 3Department of Cardiology, Duzce University Faculty of Medicine, Duzce, 4Department of Infectious Diseases, 5Department of Thoracic and Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey Purpose: To determine the predictive values of D-dimer assay, Global Registry of Acute Coronary Events (GRACE and Thrombolysis in Myocardial Infarction (TIMI risk scores for adverse outcome in patients with non-ST-segment elevation myocardial infarction (NSTEMI.Patients and methods: A total of 234 patients (mean age: 57.2±11.7 years, 75.2% were males hospitalized with NSTEMI were included. Data on D-dimer assay, GRACE and TIMI risk scores were recorded. Logistic regression analysis was conducted to determine the risk factors predicting increased mortality.Results: Median D-dimer levels were 349.5 (48.0–7,210.0 ng/mL, the average TIMI score was 3.2±1.2 and the GRACE score was 90.4±27.6 with high GRACE scores (>118 in 17.5% of patients. The GRACE score was correlated positively with both the D-dimer assay (r=0.215, P=0.01 and TIMI scores (r=0.504, P=0.000. Multivariate logistic regression analysis revealed that higher creatinine levels (odds ratio =18.465, 95% confidence interval: 1.059–322.084, P=0.046 constituted the only significant predictor of increased mortality risk with no predictive values for age, D-dimer assay, ejection fraction, glucose, hemoglobin A1c, sodium, albumin or total cholesterol levels for mortality.Conclusion: Serum creatinine levels constituted the sole independent determinant of mortality risk, with no significant values for D

  14. Precatheterization Use of P2Y12 Inhibitors in Non-ST-Elevation Myocardial Infarction Patients Undergoing Early Cardiac Catheterization and In-Hospital Coronary Artery Bypass Grafting: Insights From the National Cardiovascular Data Registry®.

    Science.gov (United States)

    Badri, Marwan; Abdelbaky, Amr; Li, Shuang; Chiswell, Karen; Wang, Tracy Y

    2017-09-22

    Current guidelines recommend early P2Y 12 inhibitor administration in non-ST-elevation myocardial infarction, but it is unclear if precatheterization use is associated with longer delays to coronary artery bypass grafting (CABG) or higher risk of post-CABG bleeding and transfusion. This study examines the patterns and outcomes of precatheterization P2Y 12 inhibitor use in non-ST-elevation myocardial infarction patients who undergo CABG. Retrospective analysis was done of 20 304 non-ST-elevation myocardial infarction patients in the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry (2009-2014) who underwent catheterization within 24 hours of admission and CABG during the index hospitalization. Using inverse probability-weighted propensity adjustment, we compared time from catheterization to CABG, post-CABG bleeding, and transfusion rates between patients who did and did not receive precatheterization P2Y 12 inhibitors. Among study patients, 32.9% received a precatheterization P2Y 12 inhibitor (of these, 2.2% were given ticagrelor and 3.7% prasugrel). Time from catheterization to CABG was longer among patients who received precatheterization P2Y 12 inhibitor (median 69.9 hours [25th, 75th percentiles 28.2, 115.8] versus 43.5 hours [21.0, 71.8], P ST-elevation myocardial infarction patients who undergo early catheterization and in-hospital CABG. Despite longer delays to surgery, the majority of pretreated patients proceed to CABG <3 days postcatheterization. Precatheterization P2Y 12 inhibitor use is associated with higher risks of postoperative bleeding and transfusion. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  15. An unusual ST-segment elevation: apical hypertrophic cardiomyopathy shows the ace up its sleeve.

    Science.gov (United States)

    de Santis, Francesco; Pergolini, Amedeo; Zampi, Giordano; Pero, Gaetano; Pino, Paolo Giuseppe; Minardi, Giovanni

    2013-01-01

    Apical hypertrophic cardiomyopathy is part of the broad clinical and morphologic spectrum of hypertrophic cardiomyopathy. We report a patient with electrocardiographic abnormalities in whom acute coronary syndrome was excluded and apical hypertrophic cardiomyopathy was demonstrated by careful differential diagnosis. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  16. Unusual towering elevation of troponin I after ST-elevation myocardial infarction and intensive monitoring with echocardiography post-percutaneous coronary intervention: a case report

    Directory of Open Access Journals (Sweden)

    Suryadevara Ramya

    2010-05-01

    Full Text Available Abstract Introduction The elevation of troponin levels directly corresponds to the extent of myocardial injury. Here we present a case of a robust rise in cardiac biomarkers that correspond to extensive damage to the myocardium but did not spell doom for our patient. It is important to note that, to the best of our knowledge, this is the highest level of troponin I ever reported in the literature after a myocardial injury in an acute setting. Case presentation A 53-year-old African American man with an unknown medical history presented to the emergency room of our hospital with chest pain associated with diaphoresis and altered mental status. He required emergency intubation due to acute respiratory failure and circulatory collapse within 10 minutes of his arrival. He was started on heparin and eptifibatide (Integrilin drips but he was taken immediately for cardiac catheterization, which showed a total occlusion of his proximal left anterior descending, diffuse left circumflex disease and severe left ventricular dysfunction with segmental wall motion abnormality. He remained hypotensive throughout the procedure and an intra-aortic balloon pump was inserted for circulatory support. His urinary toxicology examination result was positive for cocaine metabolites. Serial echocardiograms showed an akinetic apex, a severely hypokinetic septum, and severe systolic dysfunction of his left ventricle. Our patient stayed at the Coronary Care Unit for a total of 15 days before he was finally discharged. Conclusion Studies demonstrate that an increase of 1 ng/ml in the cardiac troponin I level is associated with a significant increase in the risk ratio for death. The elevation of troponin I to 515 ng/ml in our patient is an unusual robust presentation which may reflect a composite of myocyte necrosis and reperfusion but without short-term mortality. Nevertheless, prolonged close monitoring is required for better outcome. We also emphasize the need for the

  17. Comparison of bioavailability and antiplatelet action of ticagrelor in patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction: A prospective, observational, single-centre study.

    Directory of Open Access Journals (Sweden)

    Piotr Adamski

    Full Text Available Data from available studies suggest that the presence of ST-elevation myocardial infarction (STEMI may be associated with delayed and attenuated ticagrelor bioavailability and effect compared with non-ST-elevation myocardial infarction (NSTEMI.In a single-center, prospective, observational trial 73 patients with myocardial infarction (STEMI n = 49, NSTEMI n = 24 underwent a pharmacokinetic and pharmacodynamic assessment after a 180 mg ticagrelor loading dose (LD. Ticagrelor and its active metabolite (AR-C124910XX plasma concentrations were determined with liquid chromatography tandem mass spectrometry, and their antiplatelet effect was measured with the VASP assay and multiple electrode aggregometry.During the first six hours after ticagrelor LD, STEMI patients had 38% and 34% lower plasma concentration of ticagrelor and AR-C124910XX, respectively, than NSTEMI (ticagrelor AUC(0-6: 2491 [344-5587] vs. 3991 [1406-9284] ng*h/mL; p = 0.038; AR-C124910XX AUC(0-6: 473 [0-924] vs. 712 [346-1616] ng*h/mL; p = 0.027. STEMI patients also required more time to achieve maximal concentration of ticagrelor (tmax: 4.0 [3.0-12.0] vs. 2.5 [2.0-6.0] h; p = 0.012. Impaired bioavailability of ticagrelor and AR-C124910XX seen in STEMI subjects was associated with diminished platelet inhibition in this group, which was most pronounced during the initial hours of treatment.Plasma concentrations of ticagrelor and AR-C124910XX during the first hours after ticagrelor LD were one third lower in STEMI than in NSTEMI patients. This reduced and delayed ticagrelor bioavailability was associated with weaker antiplatelet effect in STEMI.ClinicalTrials.gov identifier: NCT02602444 (November 09, 2015.

  18. Moderate elevation of intracellular creatine by targeting the creatine transporter protects mice from acute myocardial infarction

    Science.gov (United States)

    Lygate, Craig A.; Bohl, Steffen; ten Hove, Michiel; Faller, Kiterie M.E.; Ostrowski, Philip J.; Zervou, Sevasti; Medway, Debra J.; Aksentijevic, Dunja; Sebag-Montefiore, Liam; Wallis, Julie; Clarke, Kieran; Watkins, Hugh; Schneider, Jürgen E.; Neubauer, Stefan

    2012-01-01

    Aims Increasing energy storage capacity by elevating creatine and phosphocreatine (PCr) levels to increase ATP availability is an attractive concept for protecting against ischaemia and heart failure. However, testing this hypothesis has not been possible since oral creatine supplementation is ineffectual at elevating myocardial creatine levels. We therefore used mice overexpressing creatine transporter in the heart (CrT-OE) to test for the first time whether elevated creatine is beneficial in clinically relevant disease models of heart failure and ischaemia/reperfusion (I/R) injury. Methods and results CrT-OE mice were selected for left ventricular (LV) creatine 20–100% above wild-type values and subjected to acute and chronic coronary artery ligation. Increasing myocardial creatine up to 100% was not detrimental even in ageing CrT-OE. In chronic heart failure, creatine elevation was neither beneficial nor detrimental, with no effect on survival, LV remodelling or dysfunction. However, CrT-OE hearts were protected against I/R injury in vivo in a dose-dependent manner (average 27% less myocardial necrosis) and exhibited greatly improved functional recovery following ex vivo I/R (59% of baseline vs. 29%). Mechanisms contributing to ischaemic protection in CrT-OE hearts include elevated PCr and glycogen levels and improved energy reserve. Furthermore, creatine loading in HL-1 cells did not alter antioxidant defences, but delayed mitochondrial permeability transition pore opening in response to oxidative stress, suggesting an additional mechanism to prevent reperfusion injury. Conclusion Elevation of myocardial creatine by 20–100% reduced myocardial stunning and I/R injury via pleiotropic mechanisms, suggesting CrT activation as a novel, potentially translatable target for cardiac protection from ischaemia. PMID:22915766

  19. 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

  20. Pseudomonas aeruginosa Microcolonies in Coronary Thrombi from Patients with ST-Segment Elevation Myocardial Infarction

    DEFF Research Database (Denmark)

    Hansen, Gorm Mørk; Belstrøm, Daniel; Nilsson, Carl Martin Peter

    2016-01-01

    Chronic infection is associated with an increased risk of atherothrombotic disease and direct bacterial infection of arteries has been suggested to contribute to the development of unstable atherosclerotic plaques. In this study, we examined coronary thrombi obtained in vivo from patients with ST......-segment elevation myocardial infarction (STEMI) for the presence of bacterial DNA and bacteria. Aspirated coronary thrombi from 22 patients with STEMI were collected during primary percutaneous coronary intervention and arterial blood control samples were drawn from radial or femoral artery sheaths. Analyses were...... performed using 16S polymerase chain reaction and with next-generation sequencing to determine bacterial taxonomic classification. In selected thrombi with the highest relative abundance of Pseudomonas aeruginosa DNA, peptide nucleic acid fluorescence in situ hybridization (PNA-FISH) with universal...

  1. Sex-related differences after contemporary primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Barthélémy, Olivier; Degrell, Philippe; Berman, Emmanuel; Kerneis, Mathieu; Petroni, Thibaut; Silvain, Johanne; Payot, Laurent; Choussat, Remi; Collet, Jean-Philippe; Helft, Gerard; Montalescot, Gilles; Le Feuvre, Claude

    2015-01-01

    Whether outcomes differ for women and men after percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) remains controversial. To compare 1-year outcomes after primary PCI in women and men with STEMI, matched for age and diabetes. Consecutive women with STEMI of0.05 for all). After exclusion of patients with shock (10.7%) and out-of-hospital cardiac arrest (6.6%), death rates were even more similar (11.3% vs 11.8%; P=0.10). Female sex was not independently associated with death (odds ratio 1.01, 95% confidence interval 0.55-1.87; P=0.97). In our consecutive unselected patient population, women had similar 1-year outcomes to men matched for age and diabetes, after contemporary primary PCI for STEMI, despite having a higher risk profile at baseline. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  2. 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.

  3. PHARMACOEPIDEMIOLOGIC ANALYSIS OF ST-ELEVATION MYOCARDIAL INFARCTION REPERFUSION THERAPY AT SARATOV REGION HOSPITALS OF DIFFERENT TYPES

    Directory of Open Access Journals (Sweden)

    O. V. Reshetko

    2016-01-01

    Full Text Available Aim. To evaluate the real practice of thrombolytic therapy of patients with ST-elevation myocardial infarction (STEMI at cardiological departments of Saratov and Saratov region hospitals.Material and methods. Retrospective pharmacoepidemiologic study was carried out. Case histories of STEMI patients discharged from cardiologic departments of several central district hospitals (CDH of Saratov region, cardiologic department of one of Saratov general municipal hospitals (MH and urgent cardiology department of Saratov clinical hospital (CH in 2006 were analyzed.Results. In CH all patients received thrombolytic therapy given they did not have contraindications and were admitted to the hospital timely. Few patients received thrombolytic therapy in MH and CDH in 2006.Conclusion. Correlation between hospital type and quality of STEMI management has been revealed.

  4. Regional Longitudinal Myocardial Deformation Provides Incremental Prognostic Information in Patients with ST-Segment Elevation Myocardial Infarction

    DEFF Research Database (Denmark)

    Biering-Sorensen, Tor; Jensen, Jan Skov; Pedersen, Sune H

    2016-01-01

    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...... information to clinical and conventional echocardiographic information (Harrell's c-statistics: 0.63 vs. 0.67, p = 0.032). In addition, impaired longitudinal deformation outside the culprit lesion perfusion region was significantly associated with an adverse outcome (p...). Conclusion Regional longitudinal myocardial deformation measures, regardless if determined by TDI or 2DSE, are superior prognosticators to GLS. In addition, impaired longitudinal deformation in the inferior myocardial segment provides prognostic information over and above clinical and conventional...

  5. 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...

  6. Rivaroxaban as an Antithrombotic Agent in a Patient With ST-Segment Elevation Myocardial Infarction and Left Ventricular Thrombus

    Directory of Open Access Journals (Sweden)

    Rajeev Seecheran

    2017-03-01

    Full Text Available The incidence of left ventricular (LV thrombi in the setting of an anterior myocardial infarction has declined significantly since the advent of primary percutaneous coronary intervention coupled with contemporary antithrombotic strategies in ST-segment elevation myocardial infarctions (STE-ACS. Despite oral anticoagulation with the currently accepted, standard-of-care vitamin K antagonist, warfarin, major bleeding complications still arise. Rivaroxaban is a novel, direct oral factor X anticoagulant that has several advantageous properties, which can attenuate bleeding risk. We present a case in which a patient successfully underwent a 3-month course of rivaroxaban in addition to his dual antiplatelet regimen of aspirin and ticagrelor for his STE-ACS and LV thrombus with resultant complete dissolution.

  7. Impact of initial platelet count on baseline angiographic finding and end-points in ST-elevation myocardial infarction referred for primary percutaneous coronary intervention.

    Science.gov (United States)

    Kaplan, Sahin; Kaplan, Safiye Tuba; Kiris, Abdulkadir; Gedikli, Omer

    2014-01-01

    The baseline platelet count (BPC) in patients with acute ST elevation myocardial infarction (STEMI) may reflect the baseline anjiografic finding and may also predic long-term outcomes after primary percutaneous coronary intervention (PPCI). Available data for the value of BPC in patients with STEMI treated with PPCI are still questionable. Therefore, we sought to determine the prognostic value of BPC for baseline angiographic finding and the impact of BPC on clinical outcomes of patients treating with PPCI. Blood sample for BPC was obtained on admission in 140 consecutive patients undergoing PPCI. Patients were divided 2 groups that group-1 (104 patients): TIMI flow-grade 0 and group-2 (36 patients): TIMI flow-grade 1-3. Follow-up was performed at 1-9 months. Baseline demographics were comparable, but, BPC was significantly higher in group-1 comparing 2 (293.7±59.8x10(9)/L vs. 237.7±50.9x10(9)/L, pmeasuring of a BPC on admission may also provide further practical and therapeutic profits.

  8. Comparison of early and late clinical outcomes in patients >= 80 versus age after successful primary angioplasty for ST segment elevation myocardial infarction.

    Science.gov (United States)

    Oduncu, Vecih; Erkol, Ayhan; Tanalp, Ali Cevat; Kırma, Cevat; Bulut, Mustafa; Bitigen, Atila; Pala, Selçuk; Tigen, Kürşat; Esen, Ali M

    2013-06-01

    We aimed to compare the efficacy of primary percutaneous coronary intervention (p-PCI) in patients >=80 versus age with ST-segment elevation myocardial infarction (STEMI). We retrospectively enrolled 2213 patients with acute STEMI. The patients were prospectively followed up for a median of 42 months. Early and late clinical outcomes were compared according to age. One-hundred and seventy-nine (8.1%) of the 2213 patients were aged >=80 years. Post-procedural TIMI grade 3 flow was significantly less frequent in the age >=80 years patients (82.1% vs. 91.1%, pearly hospitalization period were significantly higher in the age >=80 years patient group. Overall rates of mortality (40% vs. 9.7%, page >=80 years patient group. However, there was no difference between the two groups with respect to the reinfarction/revascularization rates. Analysis, using the Cox proportional hazards model, revealed that age >=80 to was an independent predictor of long-term mortality (hazard ratio 2.17, 95% CI 1.23-4.17, p=0.02). Age is an independent predictor of mortality after p-PCI for STEMI. Although it seems to improve early outcomes, the efficacy of p-PCI at long-term follow-up is limited in elderly patients.

  9. Developing a Mobile Electronic D2B Checklist for Treatment of ST Elevation Myocardial Infarction Patients Who Need a Primary Coronary Intervention

    Science.gov (United States)

    Lin, Hung-Jung; Hsu, Min-Huei; Huang, Chien-Cheng; Tan, Che-Kim; Chou, Shu-Lien; Huang, Shou-Yung; Chen, Chia-Jung

    2015-01-01

    Abstract ST elevation myocardial infarction (STEMI), one main type of acute myocardial infarction with high mortality, requires percutaneous coronary intervention (PCI) with balloon inflation. Current guidelines recommend a door-to-balloon (D2B) interval (i.e., starts with the patient's arrival in the emergency department and ends when PCI with a catheter guidewire and balloon inflation crosses the culprit lesion) of no more than 90 min. However, promptly implementing PCI requires coordinating various medical teams. Checklists can be used to ensure consistency and operating sequences when executing complex tasks in a clinical routine. Developing an effective D2B checklist would enhance the care of STEMI patients who need PCI. Mobile information and communication technologies have the potential to greatly improve communication, facilitate access to information, and eliminate duplicated documentation without the limitations of space and time. In a research project by the Chi Mei Medical Center, “Developing a Mobile Electronic D2B Checklist for Managing the Treatment of STEMI Patients Who Need Primary Coronary Intervention,” a prototype version of a mobile checklist was developed. This study describes the research project and the four phases of the system development life cycle, comprising system planning and selection, analysis, design, and implementation and operation. Face-to-face interviews with 16 potential users were conducted and revealed highly positive user perception and use intention toward the prototype. Discussion and directions for future research are also presented. PMID:25615278

  10. Developing a mobile electronic D2B checklist for treatment of ST elevation myocardial infarction patients who need a primary coronary intervention.

    Science.gov (United States)

    Lin, Hung-Jung; Hsu, Min-Huei; Huang, Chien-Cheng; Liu, Chung-Feng; Tan, Che-Kim; Chou, Shu-Lien; Huang, Shou-Yung; Chen, Chia-Jung

    2015-04-01

    ST elevation myocardial infarction (STEMI), one main type of acute myocardial infarction with high mortality, requires percutaneous coronary intervention (PCI) with balloon inflation. Current guidelines recommend a door-to-balloon (D2B) interval (i.e., starts with the patient's arrival in the emergency department and ends when PCI with a catheter guidewire and balloon inflation crosses the culprit lesion) of no more than 90 min. However, promptly implementing PCI requires coordinating various medical teams. Checklists can be used to ensure consistency and operating sequences when executing complex tasks in a clinical routine. Developing an effective D2B checklist would enhance the care of STEMI patients who need PCI. Mobile information and communication technologies have the potential to greatly improve communication, facilitate access to information, and eliminate duplicated documentation without the limitations of space and time. In a research project by the Chi Mei Medical Center, "Developing a Mobile Electronic D2B Checklist for Managing the Treatment of STEMI Patients Who Need Primary Coronary Intervention," a prototype version of a mobile checklist was developed. This study describes the research project and the four phases of the system development life cycle, comprising system planning and selection, analysis, design, and implementation and operation. Face-to-face interviews with 16 potential users were conducted and revealed highly positive user perception and use intention toward the prototype. Discussion and directions for future research are also presented.

  11. Drop-out from cardiovascular magnetic resonance in a randomized controlled trial of ST-elevation myocardial infarction does not cause selection bias on endpoints

    DEFF Research Database (Denmark)

    Laursen, Peter Nørkjær; Holmvang, L.; Kelbæk, H.

    2017-01-01

    Background: The extent of selection bias due to drop-out in clinical trials of ST-elevation myocardial infarction (STEMI) using cardiovascular magnetic resonance (CMR) as surrogate endpoints is unknown. We sought to interrogate the characteristics and prognosis of patients who dropped out before...... years of follow-up were assessed and compared between CMR-drop-outs and CMR-participants using the trial screening log and the Eastern Danish Heart Registry. Results: The drop-out rate from acute CMR was 28% (n = 92). These patients had a significantly worse clinical risk profile upon admission...... as evaluated by the TIMI-risk score (3.7 (± 2.1) vs 4.0 (± 2.6), p = 0.043) and by left ventricular ejection fraction (43 (± 9) vs. 47 (± 10), p = 0.029). CMR drop-outs had a higher incidence of known hypertension (39% vs. 35%, p = 0.043), known diabetes (14% vs. 7%, p = 0.025), known cardiac disease (11% vs...

  12. 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; PPCOS. Copyright © 2016 Elsevier B.V. All rights reserved.

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

    Science.gov (United States)

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

    2014-12-01

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

  14. Relation of the aortic stiffness with the GRACE risk score in patients with the non ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Omer, Gedikli; Gokhan, Aksan; Adem, Uzun; Sabri, Demircan; Korhan, Soylu

    2014-01-01

    Current guidelines recommend clinical risk scoring systems for the patients diagnosed and determinated treatment strategy with in Non-ST-elevation elevation myocardial infarction (NSTEMI). Previous studies demonstrated association between aortic elasticity properties, stiffness and severity CAD. However, the associations between Aortic stiffness, elasticity properties and clinical risk scores have not been investigated. In the present study we have evaluated the relation between the Global Registry of Acute Coronary Events (GRACE) risk score and aortic stiffness in patients with NSTEMI. We prospectively analyzed 87 consecutive patients with NSTEMI. Aortic elastic parameter and stiffness parameter were calculated from the echocardiographically derived thoracic aortic diameters (mm/m(2)), and the measurement of pulse pressure obtained by cuff sphygmomanometry. We have categorized the patients in to two groups as low ((n = 45) (GRACE risk score ≤ 140)) and high ((n = 42) (GRACE risk score > 140)) risk group according to GRACE risk score and compare the both groups. Table 1 shows baseline characteristics of patients. Our study showed that Aortic strain was significantly low (3.5 ± 1.4, 7.9 ± 2.3 respectively, p < 0.001) and aortic stiffness index was significantly high (3.9 ± 0.38; 3 ± 0.35, respectively, p < 0.001) in the high risk group values compared to those with low risk group. The aortic stiffness index was the only independent predictor of GRACE risk score (OR: 119.390; 95% CI: 2.925-4872.8; p = 0.011) in multivariate analysis. We found a significant correlation between aortic stiffness, impaired elasticity and GRACE risk score. Aortic stiffness index was the only independent variable of the high GRACE risk score. The inclusion of aortic stiffness into the GRACE risk score could allow improved risk classification of patients with ACS at admission and this may be important in the diagnosis, follow up and treatment of the patients.

  15. 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...

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

    International Nuclear Information System (INIS)

    Mukharji, J.; Murray, S.; Lewis, S.E.; Croft, C.H.; Corbett, J.R.; Willerson, J.T.; Rude, R.E.

    1984-01-01

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

  17. Elevated Serum Neopterin is Associated with Increased Risk of Cardiovascular Events in Acute Coronary Syndromes

    Directory of Open Access Journals (Sweden)

    Anwar Santoso

    2009-04-01

    Full Text Available BACKGROUND: Neopterin is a soluble biomarker of monocyte activation and its increased concentration might be expressed in atherosclerosis. Until recently, there has been lacking of information on the prognostic role of neopterin in acute coronary syndromes (ACS. The study was aimed at measuring the associations between elevated serum neopterin and increased risk of cardiovascular (CV events in ACS. METHODS: This was a prospective cohort study, recruited 71 ACS patients from January 31 through August 31, 2007 in Sanglah Hospital of Udayana School of Medicine, Denpasar, Bali. Cardiovascular events, such as: CV death, recurrent myocardial infarction, stroke and recurrent myocardial ischemia were previously defined. Relative risk and survival rate were measured successively by Cox proportional model and Kaplan-Meier curve. RESULTS: Of 71 ACS patients aged 56.8±9.5 years, 21 (29.5% subjects underwent CV events. Overall mean followup was 151.6 (95% CI: 129.7-173.5 days. Baseline characteristic were similarly distributed between groups with the highest quartile neopterin level (≥14.7 nmol/L than those with lowest quartile (≤6.2 nmol/L. Patients with the highest quartile had the worst survival curve than those with the lowest quartile (log-rank test; p=0.047. On Cox proportional model, relative risk of highest quartile group was 5.84 (95% CI: 1.19-28.47; p=0.029 compared to lowest quartile, after being adjusted with other predictors. CONCLUSIONS: Elevated serum neopterin is associated with increased risk of CV events in acute coronary syndromes. KEYWORDS: neopterin, cardiovascular events, acute coronary syndromes.

  18. Acute renal failure, thrombocytopenia, and elevated liver enzymes after concurrent abuse of alcohol and cocaine

    Directory of Open Access Journals (Sweden)

    Alireza Hosseinnezhad

    2011-05-01

    Full Text Available Cocaine has been associated with known adverse effects on cardiac, cerebrovascular and pulmonary systems. However, the effect of cocaine on other organs has not been extensively reported. A middle age man presented with abdominal pain and nausea after inhalation of crack cocaine. On admission, he was found to be hypertensive and tachycardic. Physical examination revealed mild abdominal tenderness without rebound. Laboratory investigations were significant for acute kidney failure with elevated serum creatinine (3.72 mg/dL, thrombocytopenia (platelet count 74,000/UL, elevated alanine and aspartate transaminases (ALT 331 U/L; AST 462 U/L and elevated creatine phosphokinase (CPK 5885 U/L. Urine toxicology screening solely revealed cocaine. A clinical diagnosis of cocaine toxicity was made and patient was admitted to the intensive care unit because of multi organ failure. Despite downward trending of liver enzymes during the hospital course, he continued to have residual renal insufficiency and a low platelet count at the time of discharge. In a patient with history of recent cocaine use presenting with these manifestations, cocaine itself should be considered as a likely cause.

  19. 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

    2017-01-01

    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 o...

  20. Short-term Elevation of Fine Particulate Matter Air Pollution and Acute Lower Respiratory Infection.

    Science.gov (United States)

    Horne, Benjamin D; Joy, Elizabeth A; Hofmann, Michelle G; Gesteland, Per H; Cannon, John B; Lefler, Jacob S; Blagev, Denitza P; Korgenski, E Kent; Torosyan, Natalie; Hansen, Grant I; Kartchner, David; Pope Iii, C Arden

    2018-04-13

    Nearly 60% of U.S. children live in counties with PM2.5 concentrations above air quality standards. Understanding the relationship between ambient air pollution exposure and health outcomes informs actions to reduce exposure and disease risk. To evaluate the association between ambient PM2.5 levels and healthcare encounters for acute lower respiratory infection (ALRI). Using an observational case-crossover design, subjects (N=146,397) were studied if they had an ALRI diagnosis and resided on Utah's Wasatch Front. PM2.5 air pollution concentrations were measured using community-based air quality monitors between 1999 and 2016. Odds ratios (OR) for ALRI healthcare encounters were calculated after stratification by ages 0-2, 3-17, and 18+ years. Approximately 77% (n=112,467) of subjects were 0-2 years of age. The odds of ALRI encounter for these young children increased within 1 week of elevated PM2.5 and peaked after 3 weeks with a cumulative 28-day OR= 1.15 per +10 μg/m3 (95% CI= 1.12, 1.19). ALRI encounters with diagnosed and laboratory-confirmed RSV and influenza increased following elevated ambient PM2.5 levels. Similar elevated odds for ALRI were also observed for older children, although the number of events and precision of estimates were much lower. In this large sample of urban/suburban patients, short-term exposure to elevated PM2.5 air pollution was associated with greater healthcare utilization for ALRI in both young children, older children, and adults. Further exploration is needed of causal interactions between PM2.5 and ALRI.

  1. Long-term clinical outcomes of the left ventricular thrombus in patients with ST elevation anterior myocardial infarction

    Directory of Open Access Journals (Sweden)

    Mahmoud Ebrahimi

    2015-01-01

    Full Text Available BACKGROUND: This study was performed to determine the size of left ventricular thrombus (LVT, risk of systemic embolization and response to medical treatment during 18 months of follow up in the patients with anterior-ST elevation myocardial infarction (aSTEMI. METHODS: This cross-sectional study was performed on thirty-five patients with anterior myocardial infarction (MI, in Emam Reza Hospital and Ghaem Hospital, Mashhad, Iran, from August 2008 to January 2011. Warfarin was prescribed for all the patients. Transthoracic echocardiographic study was performed on the 1st, 2nd, 4th, 6th, 12th and 18th months. Outcomes included rate of death, MI, stroke, systemic embolization, major bleeding and change in thrombus size following treatment. RESULTS: The resolve rate of clot on the 2nd, 4th, 6th, 12th and 18th months was 64.7, 86.6, 81.4, 81.4 and 100 percent, respectively. In five patients with complete clot resolution, clot reformation occurred after warfarin discontinuation. In these patients, left ventricular ejection fraction (LVEF improvement was poor. During the study period, five patients died due to severe heart failure. One patient developed hematuria whereas non-experienced thromboembolic events. The mean LVEF at study initiation was 30.8 ± 0.92%, which improved to 42 ± 0.84% (P < 0.05 at the end. CONCLUSION: All LVT was resolved with a combination therapy of antiplatelet and warfarin without any thromboembolic event. In patients with a poor improvement in the LV function, due to the risk of LVT reformation, lifelong warfarin therapy was recommended. 

  2. Electrocardiogram score for the selection of reperfusion strategy in early latecomers with ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Zhang, Yu-Jiao; Zheng, Wen; Sun, Jian; Li, Guo-Li; Chi, Bao-Rong

    2015-01-01

    The clinical benefit of percutaneous coronary intervention (PCI) is controversial in ST-segment elevation myocardial infarction (STEMI) patients presenting 12-72 hours after symptom onset. Several studies suggested this conflicting result was associated with myocardial area at risk (MaR) of enrolled patients. MaR could be estimated by the electrocardiogram (ECG) score. Our objective was to evaluate the benefits of PCI in STEMI latecomers with different MaR. We constructed a prospective cohort involving 436 patients presenting 12-72 hours after STEMI onset and who met an inclusion criteria. 218 underwent PCI and 218 received the optimal medical therapy (OMT) alone. Individual MaR was quantified by the combined Aldrich ST and Selvester QRS score. The primary endpoint was a composite of cardiovascular death, reinfarction or revascularization within two years. The 2-year cumulative primary endpoint rate was respectively 9.2% in PCI group and 5.3% in OMT group when MaR<35% (adjusted hazard ratio for PCI vs. OMT, 1.855; 95% confidence interval [CI], 0.617-5.575; P=0.271), and was 12.8% in PCI group and 23.1% in OMT group when MaR ≥35% (adjusted hazard ratio for PCI vs. OMT, 0.448; 95% CI, 0.228-0.884; P=0.021). The benefit of PCI for the STEMI latecomers was associated with the MaR. PCI, compared with OMT, could significantly reduce the 2-year primary outcomes in patients with MaR≥35%, but not in ones with MaR<35%. Copyright © 2015 Elsevier Inc. All rights reserved.

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    BACKGROUND: Since 2005, ST-elevation myocardial infarction (STEMI) patients from the island of Bornholm in the Baltic Sea have been transferred for primary percutaneous coronary intervention (pPCI) by an airborne service. We describe the result of pPCI as part of the Danish national reperfusion s...

  4. Long-term prognosis of patients with non-ST-segment elevation myocardial infarction according to coronary arteries atherosclerosis extent on coronary angiography

    DEFF Research Database (Denmark)

    Alzuhairi, Karam Sadoon; Søgaard, Peter; Ravkilde, Jan

    2017-01-01

    Background: Patients with non-ST-segment elevation myocardial infarction (NSTEMI) without obstructive coronary artery disease (CAD) are often managed differently than those with obstructive CAD, therefore we aimed in this study to examine the long-term prognosis of patients with NSTEMI according ...

  5. A Common Variant in SCN5A and the Risk of Ventricular Fibrillation Caused by First ST-Segment Elevation Myocardial Infarction

    DEFF Research Database (Denmark)

    Jabbari, Reza; Glinge, Charlotte; Jabbari, Javad

    2017-01-01

    Background Several common genetic variants have been associated with either ventricular fibrillation (VF) or sudden cardiac death (SCD). However, replication efforts have been limited. Therefore, we aimed to analyze whether such variants may contribute to VF caused by first ST-elevation myocardia...

  6. Left ventricular hypertrophy is associated with increased infarct size and decreased myocardial salvage in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Nepper-Christensen, Lars; Lønborg, Jacob; Ahtarovski, Kiril Aleksov

    2017-01-01

    Background--Approximately one third of patients with ST-segment elevation myocardial infarction (STEMI) have left ventricular hypertrophy (LVH), which is associated with impaired outcome. However, the causal association between LVH and outcome in STEMI is unknown. We evaluated the association bet...

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

    DEFF Research Database (Denmark)

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

    2008-01-01

    OBJECTIVES: The purpose of this study was to evaluate the use of distal protection during percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) in native coronary vessels. BACKGROUND: Embolization of material from the infarct-related lesion during PCI may...

  8. Data on administration of cyclosporine, nicorandil, metoprolol on reperfusion related outcomes in ST-segment Elevation Myocardial Infarction treated with percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Campo, Gianluca; Pavasini, Rita; Morciano, Giampaolo

    2017-01-01

    Mortality and morbidity in patients with ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) are still high [1]. A huge amount of the myocardial damage is related to the mitochondrial events happening during reperfusion [2]. Several drugs direc...

  9. Gender-related differences in outcome after BMS or DES implantation in patients with ST-segment elevation myocardial infarction treated by primary angioplasty

    DEFF Research Database (Denmark)

    De Luca, Giuseppe; Verdoia, Monica; Dirksen, Maurits T

    2013-01-01

    Several studies have found that among patients with ST-segment elevation myocardial infarction (STEMI) treated by thrombolysis, female sex is associated with a worse outcome. However, still controversial is the prognostic impact of gender in primary angioplasty, especially in the era of drug-elut...

  10. Erythrocyte-rich thrombus aspirated from patients with ST-elevation myocardial infarction: association with oxidative stress and its impact on myocardial reperfusion

    NARCIS (Netherlands)

    Yunoki, Kei; Naruko, Takahiko; Sugioka, Kenichi; Inaba, Mayumi; Iwasa, Yoko; Komatsu, Ryushi; Itoh, Akira; Haze, Kazuo; Inoue, Takeshi; Yoshiyama, Minoru; Becker, Anton E.; Ueda, Makiko

    2012-01-01

    Recent studies have demonstrated that erythrocytes are a potential component in atheromatous lesions and thrombus formation in patients with ST-elevation myocardial infarction (STEMI). The purpose of this study was to determine the associations of red blood cell (RBC) component of coronary thrombi

  11. Final infarct size measured by cardiovascular magnetic resonance in patients with ST elevation myocardial infarction predicts long-term clinical outcome

    DEFF Research Database (Denmark)

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

    2013-01-01

    AIMS: Tailored heart failure treatment and risk assessment in patients following ST-segment elevation myocardial infarction (STEMI) is mainly based on the assessment of the left ventricular (LV) ejection fraction (EF). Assessment of the final infarct size in addition to the LVEF may improve...

  12. Fractional Flow Reserve-Guided Complete Revascularization Improves the Prognosis in Patients With ST-Segment-Elevation Myocardial Infarction and Severe Nonculprit Disease

    DEFF Research Database (Denmark)

    Lønborg, Jacob; Engstrøm, Thomas; Kelbæk, Henning

    2017-01-01

    , and severity of the noninfarct-related stenosis on the effect of fractional flow reserve-guided complete revascularization. METHODS AND RESULTS: In the DANAMI-3-PRIMULTI study (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete...

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

    NARCIS (Netherlands)

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

    2014-01-01

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

  14. Predictive Value of Plasma Glucose Level on Admission for Short and Long Term Mortality in Patients With ST-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

    NARCIS (Netherlands)

    Hoebers, Loes P.; Damman, Peter; Claessen, Bimmer E.; Vis, Marije M.; Baan, Jan; van Straalen, Jan P.; Fischer, Johan; Koch, Karel T.; Tijssen, Jan G. P.; de Winter, Robbert J.; Piek, Jan J.; Henriques, Jose P. S.

    2012-01-01

    Published reports describe a strong association between plasma glucose levels on admission and mortality in patients who undergo primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. The aim of this study was to assess the predictive value of admission glucose

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

    Directory of Open Access Journals (Sweden)

    Abdelnoor Michael

    2011-07-01

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

  16. Bifurcation Culprit Lesions in ST-segment Elevation Myocardial Infarction: Procedural Success and 5-year Outcome Compared With Nonbifurcation Lesions.

    Science.gov (United States)

    Salinas, Pablo; Mejía-Rentería, Hernán; Herrera-Nogueira, Raúl; Jiménez-Quevedo, Pilar; Nombela-Franco, Luis; Núñez-Gil, Iván Javier; Gonzalo, Nieves; Del Trigo, María; Pérez-Vizcayno, María José; Quirós, Alicia; Escaned, Javier; Macaya, Carlos; Fernández-Ortiz, Antonio

    2017-08-09

    We assessed short- and long-term outcomes of primary angioplasty in ST-segment elevation myocardial infarction by comparing bifurcation culprit lesions (BCL) with non-BCL. Observational study with a propensity score matched control group. Among 2746 consecutive ST-segment elevation myocardial infarction patients, we found 274 (10%) patients with BCL. The primary outcome was a composite endpoint including all-cause death, myocardial infarction, coronary artery bypass grafting or target vessel revascularization, assessed at 30-days and 5-years. Baseline characteristics showed no differences after propensity matching (1:1). In the BCL group, the most frequent strategy was provisional stenting of the main branch (84%). Compared with the non-BCL group, the procedures were technically more complex in the BCL group in terms of need for balloon dilatation (71% BCL vs 59% non-BCL; P = .003), longer procedural time (70 ± 29minutes BCL vs 62.8 ± 28.9minutes non-BCL; P = .004) and contrast use (256.2 ± 87.9mL BCL vs 221.1 ± 82.3mL non-BCL; P < .001). Main branch angiographic success was similar (93.4% BCL vs 93.8% non-BCL; P = .86). Thirty-day all-cause mortality was similar between groups: 4.7% BCL vs 5.1% non-BCL; P = .84. At the 5-year follow-up, there were no differences in all-cause death (12% BCL vs 13% non-BCL; P = .95) or the combined event (22% BCL vs 21% non-BCL; P = .43). Primary angioplasty of a BCL was technically more complex; however, main branch angiographic success was similar, and there were no differences in long-term prognosis compared with non-BCL patients. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  17. Acute Effects of the Elevation Training Mask on Strength Performance in Recreational Weight lifters.

    Science.gov (United States)

    Jagim, Andrew R; Dominy, Trevor A; Camic, Clayton L; Wright, Glenn; Doberstein, Scott; Jones, Margaret T; Oliver, Jonathan M

    2018-02-01

    Jagim, AR, Dominy, TA, Camic, CL, Wright, G, Doberstein, S, Jones, MT, and Oliver, JM. Acute effects of the elevation training mask on strength performance in recreational weightlifters. J Strength Cond Res 32(2): 482-489, 2018-The Elevation Training Mask 2.0 (ETM) is a novel device that purportedly simulates altitude training. The purpose of this study was to investigate the acute effects of the ETM on resistance exercise performance, metabolic stress markers, and ratings of mental fatigue. Twenty male recreational weight lifters completed 2 training sessions of back squat and bench press (6 sets of 10 repetitions at 85% of 5-repetition maximum and seventh set to failure) as well as a maximal effort sprint test (18% body mass) with the mask (ETM) and without the mask (NM). Training evaluation included baseline and postexercise blood lactate and oxygen saturation measures. Performance evaluation included peak and average velocity bar velocity, total volume load, total work, total repetitions completed, and sprint performance. Adverse side effects were reported in 12% (n = 3) of participants, which included feelings of light headedness, anxiety, and discomfort. No differences were found in repetitions or total workload in back squat (p = 0.07) or bench press (p = 0.08) between conditions. A lower peak velocity was identified during the back squat, bench press, and sprint test in the ETM condition (p = 0.04). Blood lactate values were lower after bench press and sprint during the ETM condition (p bench press, and sprint test in the ETM condition compared with the NM condition (p velocity during training bouts and negatively influence ratings of alertness and focus for task.

  18. Influence of left ventricular hypertrophy on infarct size and left ventricular ejection fraction in ST-elevation myocardial infarction

    International Nuclear Information System (INIS)

    Małek, Łukasz A.; Śpiewak, Mateusz; Kłopotowski, Mariusz; Petryka, Joanna; Mazurkiewicz, Łukasz; Kruk, Mariusz; Kępka, Cezary; Miśko, Jolanta; Rużyłło, Witold; Witkowski, Adam

    2012-01-01

    Background: Left ventricular hypertrophy (LVH) predisposes to larger infarct size, which may be underestimated by the left ventricular ejection fraction (LVEF) due to supranormal systolic performance often present in patients with LVH. The aim of the study was to compare infarct size and LVEF in patients with ST-segment elevation myocardial infarction (STEMI) and increased left ventricular mass on cardiac magnetic resonance (CMR). Methods: The study included unselected group of 52 patients (61 ± 11 years, 69% male) with first STEMI who had CMR after median 5 days from the onset of the event. Left ventricular hypertrophy (LVH) was defined as left ventricular mass index exceeding 95th percentile of references values for age and gender. Infarct size was assessed with means of late gadolinium enhancement (LGE). Results: LVH was found in 16 patients (31%). In comparison to the rest of the group, patients with LVH had higher absolute and relative infarct mass (p = 0.002 and p = 0.02, respectively). LVH was related to higher prevalence of microvascular obstruction and myocardial haemorrhage and higher number of LV segments with transmural necrosis (p = 0.02, p = 0.01 and p = 0.01, respectively). Despite marked difference in the infarct size between both studied subgroups there was no difference in LVEF and mean number of dysfunctional LV segments. Conclusions: Patients with LVH undergoing STEMI have larger infarct size underestimated by the LV systolic performance in comparison to patients without LVH.

  19. Thrombus aspiration in patients with ST-elevation myocardial infarction: results of a national registry of interventional cardiology.

    Science.gov (United States)

    Pereira, Hélder; Caldeira, Daniel; Teles, Rui Campante; Costa, Marco; da Silva, Pedro Canas; da Gama Ribeiro, Vasco; Brandão, Vítor; Martins, Dinis; Matias, Fernando; Pereira-Machado, Francisco; Baptista, José; Abreu, Pedro Farto E; Santos, Ricardo; Drummond, António; de Carvalho, Henrique Cyrne; Calisto, João; Silva, João Carlos; Pipa, João Luís; Marques, Jorge; Sousa, Paulino; Fernandes, Renato; Ferreira, Rui Cruz; Ramos, Sousa; Oliveira, Eduardo Infante; de Sousa Almeida, Manuel

    2018-04-24

    We aimed to evaluate the impact of thrombus aspiration (TA) during primary percutaneous coronary intervention (P-PCI) in 'real-world' settings. We performed a retrospective study, using data from the National Registry of Interventional Cardiology (RNCI 2006-2012, Portugal) with ST-elevation myocardial infarction (STEMI) patients treated with P-PCI. The primary outcome, in-hospital mortality, was analysed through adjusted odds ratio (aOR) and 95% confidence intervals (95%CI). We assessed data for 9458 STEMI patients that undergone P-PCI (35% treated with TA). The risk of in-hospital mortality with TA (aOR 0.93, 95%CI:0.54-1.60) was not significantly decreased. After matching patients through the propensity score, TA reduced significantly the risk of in-hospital mortality (OR 0.58, 95%CI:0.35-0.98; 3500 patients). The whole cohort data does not support the routine use of TA in P-PCI, but the results of the propensity-score matched cohort suggests that the use of selective TA may improve the short-term risks of STEMI.

  20. Heart failure complicating myocardial infarction. A report of the Peruvian Registry of ST-elevation myocardial infarction (PERSTEMI).

    Science.gov (United States)

    Chacón-Diaz, Manuel; Araoz-Tarco, Ofelia; Alarco-León, Walter; Aguirre-Zurita, Oscar; Rosales-Vidal, Maritza; Rebaza-Miyasato, Patricia

    2018-05-01

    The aim of this study is to determine the incidence, associated factors, and 30-day mortality of patients with heart failure (HF) after ST elevation myocardial infarction (STEMI) in Peru. Observational, cohort, multicentre study was conducted at the national level on patients enrolled in the Peruvian registry of STEMI, excluding patients with a history of HF. A comparison was made with the epidemiological characteristics, treatment, and 30 day-outcome of patients with (Group 1) and without (Group 2) heart failure after infarction. Of the 388 patients studied, 48.7% had symptoms of HF, or a left ventricular ejection fraction 75 years, anterior wall infarction, and the absence of electrocardiographic signs of reperfusion were the factors related to a higher incidence of HF. The hospital mortality in Group 1 was 20.6%, and the independent factors related to higher mortality were age>75 years, and the absence of electrocardiographic signs of reperfusion. Heart failure complicates almost 50% of patients with STEMI, and is associated with higher hospital and 30-day mortality. Age greater than 75 years and the absence of negative T waves in the post-reperfusion ECG are independent factors for a higher incidence of HF and 30-day mortality. Copyright © 2018 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

  1. An alarming trend: Change in the risk profile of patients with ST elevation myocardial infarction over the last two decades.

    Science.gov (United States)

    Mentias, Amgad; Hill, Elizabeth; Barakat, Amr F; Raza, Mohammad Q; Youssef, Dalia; Banerjee, Kinjal; Sawant, Abhishek C; Ellis, Stephen; Murat Tuzcu, E; Kapadia, Samir R

    2017-12-01

    Coronary artery disease (CAD) is the leading cause of mortality around the world. We sought to study changes in the risk profile of patients presenting with ST elevation myocardial infarction (STEMI). We retrospectively studied all patients presenting with STEMI to our center between 1995 and 2014. Patients were divided into four quartiles, 5years each. Baseline risk factors and comorbidities were recorded. Sub-analysis was done for patients with established CAD and their household incomes. A total of 3913 patients (67.9% males) were included; 42.5% presented with anterior STEMI and 57.5% inferior STEMI. Ages were 64±12, 62±13, 61±13 and 60±13 in the four quartiles respectively. Obesity prevalence was 31, 37, 38 and 40% and diabetes mellitus prevalence was 24, 25, 24 and 31%, while hypertension was 55, 67, 70 and 77%, respectively, prisk factors and more focus on preventive cardiology, patients presenting with STEMI over the past 20years are getting younger and more obese, with more prevalence of smoking, hypertension, and diabetes mellitus. This trend is greater in the lower income population. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Multidetector row computed tomography noninvasively assesses coronary reperfusion after thrombolytic therapy in patients with ST elevation myocardial infarction

    International Nuclear Information System (INIS)

    Shin, Dong-Il; Won, Yoo-Dong; Chang, Kiyuk

    2006-01-01

    The study objective was to assess the efficacy of 16-slice multidetector row computed tomography (MDCT) in estimating residual stenosis and successful reperfusion after thrombolysis in patients with ST-elevation myocardial infarction (STEMI). A total of 31 patients with STEMI underwent MDCT scanning within 6 h (mean 4.6±1.1) after thrombolysis and the results for detection of significant residual stenosis and distal flow of the infarct-related artery were compared with those from conventional coronary angiography (CCAG) performed within 24 h (mean 12.1±5.6) after the MDCT scan. Successful reperfusion was defined as Thrombolysis In Myocardial Infarction flow 2 or 3 on CCAG and full contrast enhancement of the distal artery landmarks on MDCT. A final analysis was performed using 24 patients (312 segments). MDCT had a positive predictive value of 73.3% and a negative predictive value of 95.1% for detecting significant residual stenosis. It accurately estimated 17 of 18 patients (94.4%) with successful reperfusion and 5 of 6 (83.3%) with failed reperfusion on the basis of comparison with CCAG. MDCT demonstrated high accuracy not only for the detecting residual stenosis, but also for assessing successful reperfusion after thrombolytic therapy in patients with STEMI. (author)

  3. Outcomes of patients in clinical trials with ST-segment elevation myocardial infarction among countries with different gross national incomes.

    Science.gov (United States)

    Orlandini, Andrés; Díaz, Rafael; Wojdyla, Daniel; Pieper, Karen; Van de Werf, Frans