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Sample records for acute st-segment elevation

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

    Directory of Open Access Journals (Sweden)

    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.

  2. 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....

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

    Institute of Scientific and Technical Information of China (English)

    Jean-Pierre Bassand

    2008-01-01

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

  4. 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...

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

    OpenAIRE

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

    2009-01-01

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

  6. 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.

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

    Institute of Scientific and Technical Information of China (English)

    傅晓霞; 肖文剑; 吕健; 吴乐文; 杨帆

    2009-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

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

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

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

    1995-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    叶明

    2014-01-01

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

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

    NARCIS (Netherlands)

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

    2009-01-01

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

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

  13. Acute Coronary Syndrome and ST Segment Monitoring.

    Science.gov (United States)

    Carey, Mary G

    2016-09-01

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

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

    Institute of Scientific and Technical Information of China (English)

    段晓霞

    2013-01-01

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

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

    OpenAIRE

    Markandeya Rao; Ravindra Kumar; Nanditha

    2015-01-01

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

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

    Science.gov (United States)

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

    2013-07-15

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

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

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    S. R. Gilyarevskiy

    2015-12-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    张大鹏

    2014-01-01

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

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

    International Nuclear Information System (INIS)

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

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

    NARCIS (Netherlands)

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

    2010-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    刘晓宇

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Markandeya Rao

    2015-12-01

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

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

    DEFF Research Database (Denmark)

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

    2007-01-01

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

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

    Science.gov (United States)

    Dauerman, Harold L; Sobel, Burton E

    2012-08-01

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

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

    Science.gov (United States)

    Lindow, Thomas; Pahlm, Olle; Nikus, Kjell

    2016-01-01

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

  7. 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.

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

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    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.

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

    Science.gov (United States)

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

    2014-01-01

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

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

    DEFF Research Database (Denmark)

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

    2009-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    姚怡

    2013-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    张优

    2014-01-01

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

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

    NARCIS (Netherlands)

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

    2010-01-01

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

  14. 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...

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

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

    OpenAIRE

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

    2015-01-01

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

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

    NARCIS (Netherlands)

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

    2012-01-01

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

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

    NARCIS (Netherlands)

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

    2009-01-01

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

  19. 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.

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

    Institute of Scientific and Technical Information of China (English)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Bo Zhang

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Zohair Al Aseri

    2011-01-01

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

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

    OpenAIRE

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

    2010-01-01

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

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

    OpenAIRE

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

    2009-01-01

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

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

    International Nuclear Information System (INIS)

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

  6. 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.

  7. 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.

  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)

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

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

    Wong Dennis TL

    2011-10-01

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

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

    OpenAIRE

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

    2015-01-01

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

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

    OpenAIRE

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

    2011-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

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

  14. 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...

  15. 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.)

  16. 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.

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

    DEFF Research Database (Denmark)

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

    2007-01-01

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

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

    NARCIS (Netherlands)

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

    2009-01-01

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

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

    NARCIS (Netherlands)

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

    2009-01-01

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

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

    NARCIS (Netherlands)

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

    2011-01-01

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

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

    Science.gov (United States)

    Tubaro, Marco; Sonia Petronio, Anna

    2009-10-01

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

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

    Science.gov (United States)

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

    2016-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Dan BAO

    2015-06-01

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

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

    NARCIS (Netherlands)

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

    1991-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    付艳东; 高海春; 刘丽

    2013-01-01

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

  6. 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.

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

    Science.gov (United States)

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

    1997-06-15

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

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

    OpenAIRE

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

    2014-01-01

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

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

    OpenAIRE

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

    2015-01-01

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

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

    Science.gov (United States)

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

    2006-09-01

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

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

    Directory of Open Access Journals (Sweden)

    D. A. Kuzhel

    2015-09-01

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

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

    OpenAIRE

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

    2013-01-01

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

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

    Science.gov (United States)

    Chang, Hung-Yu; Yang, Yung-Nien

    2011-01-01

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

  14. 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.

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

    Directory of Open Access Journals (Sweden)

    Óscar Fabregat-Andrés

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

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

    Institute of Scientific and Technical Information of China (English)

    Wei Wei; Chufan Luo; Zhimin Du

    2008-01-01

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

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

    Science.gov (United States)

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

    2016-09-01

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

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

    OpenAIRE

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

    2013-01-01

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

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

    OpenAIRE

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

    2016-01-01

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

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

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    Dorokhova O.V.

    2014-12-01

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

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

    Institute of Scientific and Technical Information of China (English)

    Liu Yangchun; Su Qiang; Li Lang

    2014-01-01

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

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

    DEFF Research Database (Denmark)

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

    2009-01-01

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

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

    DEFF Research Database (Denmark)

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

    2009-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Matthew A Silva

    2006-03-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2009-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Loïc Bière

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

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

    Directory of Open Access Journals (Sweden)

    Posnenkova О.М.

    2014-09-01

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

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

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    Jose F. Chavez

    2015-01-01

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

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

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    Luiz Ricardo A. Castro

    2011-12-01

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

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

    Science.gov (United States)

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

    2012-10-01

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

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

    NARCIS (Netherlands)

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

    1997-01-01

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

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

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    Panina A.V.

    2013-12-01

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

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

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    Rodrigo Martins Brandão

    2013-03-01

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

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

    NARCIS (Netherlands)

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

    2006-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    李英

    2015-01-01

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

  16. 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.

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

    Science.gov (United States)

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

    2014-07-15

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

  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...... studied 144 patients treated with primary percutaneous coronary intervention. We aimed to define the association between infarct size as determined by cardiac magnetic resonance imaging and different metrics of ST-segment recovery. Electrocardiograms were assessed at baseline and 90 minutes after primary...... percutaneous coronary intervention. Three methods for calculating and categorizing ST-segment recovery were used: (1) summed ST-segment deviation (STD) resolution analyzed in 3 categories (> or = 70%, > or = 30% to or = 2 mm). Infarct size and ejection fraction were assessed at 4 months by cardiac magnetic...

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

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    Leticia Bôa-Hora Rodrigues

    2015-10-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2011-01-01

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

  1. 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...

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

    Institute of Scientific and Technical Information of China (English)

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

    2011-01-01

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

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

    OpenAIRE

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    OpenAIRE

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

    2007-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Raimundo Carmona Puerta

    2010-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Ker James

    2009-03-01

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

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

    Institute of Scientific and Technical Information of China (English)

    韩瑞梅; 高方明

    2011-01-01

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

  11. 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

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

    Science.gov (United States)

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

    2016-07-01

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

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

    Institute of Scientific and Technical Information of China (English)

    王立军; 王晓军; 蔡卫东; 崔连群

    2002-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Eroğlu M et al.

    2011-02-01

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

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

    OpenAIRE

    Eroğlu M et al.

    2011-01-01

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

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

    NARCIS (Netherlands)

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

    2011-01-01

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

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

    OpenAIRE

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

    2006-01-01

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

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

    DEFF Research Database (Denmark)

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

    2010-01-01

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

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

    Science.gov (United States)

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

    2016-06-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2014-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    舒政; 邓小飞; 张家美; 葛琛瑾; 孟文斌

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    D. B. Nemick

    2015-12-01

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

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

    NARCIS (Netherlands)

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

    2005-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    赵荣诚; 于靖; 颜利求; 王钢; 韩立宪

    2012-01-01

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

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

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

    Science.gov (United States)

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

    2016-09-01

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

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

    OpenAIRE

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

    2001-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    李东宝; 陈文明; 华琦; 刘志

    2012-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    李雪

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Jessica Carolina Matos D'Almeida Santos

    2013-05-01

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

  12. 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.

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

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  14. 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 ...

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

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

    DEFF Research Database (Denmark)

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

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Bensujin

    2014-05-01

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

  18. 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....

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    Alok; Deshpande; Yochai; Birnbaum

    2014-01-01

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

  1. 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.

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

    Science.gov (United States)

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

    2013-08-01

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

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

    DEFF Research Database (Denmark)

    Bangalore, Sripal; Toklu, Bora; Wetterslev, Jørn

    2015-01-01

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

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

    Science.gov (United States)

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

    2014-08-01

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

  5. 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)....

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

    Institute of Scientific and Technical Information of China (English)

    Manish Pradhan; Shuxian Zhou; Juan Lei; Zesheng Liu

    2008-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2015-01-01

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

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

    Science.gov (United States)

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

    2005-04-01

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

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

    Directory of Open Access Journals (Sweden)

    Gamma Reto

    2011-08-01

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

  10. ST-segment resolution with bivalirudin versus heparin and routine glycoprotein IIb/IIIa inhibitors started in the ambulance in ST-segment elevation myocardial infarction patients transported for primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Van't Hof, Arnoud; Giannini, Francesco; Ten Berg, Jurrien;

    2015-01-01

    BACKGROUND: Myocardial reperfusion after primary percutaneous coronary intervention (PCI) can be assessed by the extent of post-procedural ST-segment resolution. The European Ambulance Acute Coronary Syndrome Angiography (EUROMAX) trial compared pre-hospital bivalirudin and pre-hospital heparin...... with electrocardiographic data available in 824 patients (95%). Residual ST-segment deviation one hour after PCI was 3.8±4.9 mm versus 3.9±5.2 mm for bivalirudin and heparin+GPI, respectively (p=0.0019 for non-inferiority). Overall, there were no differences between randomized treatments in any measures of ST......-segment resolution either before or after the index procedure. CONCLUSIONS: Pre-hospital treatment with bivalirudin is non-inferior to pre-hospital heparin + GPI with regard to residual ST-segment deviation or ST-segment resolution, reflecting comparable myocardial reperfusion with the two strategies....

  11. Effect of Coronary Thrombectomy in Cardiogenic Shock Complicating ST-Segment Elevation Myocardial Infarction.

    Science.gov (United States)

    Suzuki, Makoto; Sumiyoshi, Tetsuya; Miyachi, Hideki; Yamashita, Jun; Yamasaki, Masao; Miyauchi, Katsumi; Yamamoto, Takeshi; Nagao, Ken; Tomoike, Hitonobu; Takayama, Morimasa

    2015-06-15

    Optimal coronary reflow is the critical key issue to ameliorate clinical outcomes in patients with cardiogenic shock complicating ST-segment elevation myocardial infarction (Shock-STEMI). We investigated our hypothesis that pre-percutaneous coronary intervention (PCI) procedural coronary thrombectomy may provide clinical advantages to attempt optimal coronary reflow in patients with Shock-STEMI. Of 7,650 patients with acute myocardial infarction registered in the Tokyo CCU Network Scientific Council from January 2009 to December 2011, a total of 180 consecutive patients (144 men, 68 ± 13 years) with Shock-STEMI who showed pre-PCI procedural Thrombolysis in Myocardial Infarction flow grade 0 (absent initial coronary flow) were recruited. Achievements of post-PCI procedural Thrombolysis in Myocardial Infarction flow grade 3 (optimal coronary reflow) and also in-hospital mortality were evaluated in those in accordance with and without coronary thrombectomy. Coronary thrombectomy was performed in 128 patients with Shock-STEMI (71% of all). Overall in-hospital mortality was 41% and that in anterior Shock-STEMI with a necessity of mechanical circulatory support increased by 59% (i.e., profound shock). Coronary thrombectomy did not affect any improvements in the achievement of optimal coronary reflow (65% vs 58%, p = 0.368) and in-hospital mortality (42% vs 37%, p = 0.484) in these patients. Even when focused on 76 patients with profound shock, neither an achievement of optimal coronary reflow (56% vs 47%, p = 0.518) nor in-hospital mortality (58% vs 65%, p = 0.601) were different between with and without coronary thrombectomy. Multivariate logistic analysis did not demonstrate any association of coronary thrombectomy (p = 0.798), left main Shock-STEMI (p = 0.258), and use of mechanical circulatory support (p = 0.119) except a concentration of hemoglobin (for each 1 g/dl increase, odds ratio 1.247, 95% confidence interval 1.035 to 1.531, p = 0.019) with optimal

  12. Intravenous Erythropoietin in Patients with ST-Segment Elevation Myocardial Infarction

    Science.gov (United States)

    Najjar, Samer S.; Rao, Sunil V.; Melloni, Chiara; Raman, Subha V.; Povsic, Thomas J.; Melton, Laura; Barsness, Gregory W.; Prather, Kristi; Heitner, John F.; Kilaru, Rakhi; Gruberg, Luis; Hasselblad, Vic; Greenbaum, Adam B.; Patel, Manesh; Kim, Raymond J.; Talan, Mark; Ferrucci, Luigi; Longo, Dan L.; Lakatta, Edward G.; Harrington, Robert A.

    2012-01-01

    Context Acute ST-segment elevation myocardial infarction (STEMI) is a leading cause of morbidity and mortality. In experimental models of MI, erythropoietin reduces infarct size and improves left ventricular (LV) function. Objective To evaluate the safety and efficacy of a single intravenous bolus of epoetin alfa in patients with STEMI. Design, Setting, and Patients Prospective, randomized, double-blind, placebo-controlled trial with a dose-escalation safety phase and a single-dose (60,000 units of epoetin alfa) efficacy phase involving 222 patients with STEMI who underwent successful percutaneous coronary intervention (PCI) as a primary or rescue reperfusion strategy. Intervention Participants were randomly assigned to treatment with intravenous epoetin alfa or matching saline placebo administered within 4 hours of reperfusion. Main Outcome Measure Infarct size, expressed as a percentage of LV mass, assessed by cardiac magnetic resonance (CMR) imaging 2–6 days after study medication administration. Results In the efficacy cohort (n=138), infarct size did not differ between groups at either 2–6 days (15.8±10.3 vs. 15.0±10.0, P=.666) or 12±2 weeks (10.6±8.6 vs. 10.4±7.6, P=.886). Left ventricular ejection fraction also did not differ between groups at either the early (48.2±9.1 vs. 48.9±8.7, P=.671) or late (52.5±9.3 vs. 52.0±8.8, P=.760) timepoints. In pre-specified analyses of patients aged ≥70 years (n=21), mean infarct size within the first week was larger in the epoetin alfa arm than in the placebo group (19.9±9.9 vs.11.7±7.2, P=.026). Patients who received epoetin alfa had a higher incidence of the composite endpoint of death, myocardial infarction, stroke, or stent thrombosis (4.0% vs. 0.0%, P=.042), and a higher incidence of serious adverse events (20.0% vs. 10.3%, P=.052). Conclusions In STEMI patients successfully reperfused with primary or rescue PCI, a single intravenous bolus of epoetin alfa did not reduce infarct size and was

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

    OpenAIRE

    V. A. Sulimov

    2015-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    郭胜

    2013-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2012-01-01

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

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

    NARCIS (Netherlands)

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

    2016-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    夏经钢; 曲杨; 胡少东; 许骥; 尹春琳; 徐东

    2015-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2010-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    徐莉(综述); 马依彤(审校)

    2015-01-01

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

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

    International Nuclear Information System (INIS)

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

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

    DEFF Research Database (Denmark)

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

    2012-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    张宇晨

    2013-01-01

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

  3. 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...

  4. 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...

  5. 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

    percutaneous coronary intervention. Three methods for calculating and categorizing ST-segment recovery were used: (1) summed ST-segment deviation (STD) resolution analyzed in 3 categories (> or = 70%, > or = 30% to or = 2 mm). Infarct size and ejection fraction were assessed at 4 months by cardiac magnetic...... resonance imaging. All 3 ST-segment recovery algorithms predicted the final infarct size and cardiac function. Worst-lead residual STD performed the same as, or better than, the more complex methods and identified large subgroups at either end of the risk spectrum (median infarct size from the lowest...

  6. Comparison of Triggering and Nontriggering Factors in ST-Segment Elevation Myocardial Infarction and Extent of Coronary Arterial Narrowing.

    Science.gov (United States)

    Ben-Shoshan, Jeremy; Segman-Rosenstveig, Yafit; Arbel, Yaron; Chorin, Ehud; Barkagan, Michael; Rozenbaum, Zach; Granot, Yoav; Finkelstein, Ariel; Banai, Shmuel; Keren, Gad; Shacham, Yacov

    2016-04-15

    Various physical, emotional, and extrinsic triggers have been attributed to acute coronary syndrome. Whether a correlation can be drawn between identifiable ischemic triggers and the nature of coronary artery disease (CAD) still remains unclear. In the present study, we evaluated the correlation between triggered versus nontriggered ischemic symptoms and the extent of CAD in patients with ST-segment elevation myocardial infarction (STEMI). We conducted a retrospective, single-center observational study including 1,345 consecutive patients with STEMI, treated with primary percutaneous coronary intervention. Acute physical and emotional triggers were identified in patients' historical data. Independent predictors of multivessel CAD were determined using a logistic regression model. A potential trigger was identified in 37% of patients. Physical exertion was found to be the most dominant trigger (65%) followed by psychological stress (16%) and acute illness (12%). Patients with nontriggered STEMI tended to be older and more likely to have co-morbidities. Patients with nontriggered STEMI showed a higher rate of multivessel CAD (73% vs 30%, p <0.001). In a multivariate regression model, nontriggered symptoms emerged as an independent predictor of multivessel CAD (odds ratio 8.33, 95% CI 5.74 to 12.5, p = 0.001). No specific trigger was found to predict independently the extent of CAD. In conclusion, symptoms onset without a recognizable trigger is associated with multivessel CAD in STEMI. Further studies will be required to elucidate the putative mechanisms underlying ischemic triggering.

  7. 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)....

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

    Directory of Open Access Journals (Sweden)

    Lukasz Lewicki

    2015-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    张宏伟; 许虹; 李元红; 及心

    2012-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    杜英; 兰军; 陈杰民; 蔡振明; 董家龙

    2015-01-01

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

  11. Factors Associated With and Outcomes After Ventricular Fibrillation Before and During Primary Angioplasty in Patients With ST-Segment Elevation Myocardial Infarction

    DEFF Research Database (Denmark)

    Jabbari, Reza; Risgaard, Bjarke; Fosbol, Emil L;

    2015-01-01

    We aimed to assess the risk factors and outcome of ventricular fibrillation (VF) before and duringprimary percutaneous coronary intervention (PPCI) in patients with ST-segment elevationmyocardial infarction. From 1999 to 2012, we consecutively enrolled 5,373 patients withST-segment elevation myoc...

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

    Institute of Scientific and Technical Information of China (English)

    吴坤生

    2015-01-01

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

  13. Systematic use of transradial PCI in patients with ST-segment elevation myocardial infarction: a call to "arms".

    Science.gov (United States)

    Eleid, Mackram F; Rihal, Charanjit S; Gulati, Rajiv; Bell, Malcolm R

    2013-11-01

    A growing body of evidence now supports the use of transradial percutaneous intervention (TRI) as the preferred access site for the treatment of patients with ST-segment elevation myocardial infarction (STEMI). Historically, TRI has been avoided in the STEMI population due to concerns over longer procedure time, longer door-to-device time, higher crossover rates, and the experience level required with TRI compared with transfemoral access. However, in recent years, recognition of the impact of periprocedural bleeding on mortality in patients with acute coronary syndromes has garnered interest in the utility of TRI as an established method to reduce bleeding. Registry data, meta-analyses, and randomized control trials all similarly demonstrate that TRI is associated with reduced periprocedural bleeding and lower mortality compared with transfemoral access in the STEMI population. Additional benefits of TRI include enhanced patient comfort, reduced hospital length of stay, and reduced cost. Despite the evidence, trends in use of TRI in the United States have shown a slow adoption rate as a result of multiple barriers in clinical practice and doubts about the mechanism and causal relationship of mortality reduction with TRI. We summarize the current evidence and propose a call to action to foster training of TRI in cardiovascular fellowship programs and post-fellowship courses, and for more widespread implementation of TRI in STEMI patients. PMID:24262613

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

    Institute of Scientific and Technical Information of China (English)

    简芳

    2012-01-01

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

  15. 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

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

    Institute of Scientific and Technical Information of China (English)

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

    2014-01-01

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

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

    DEFF Research Database (Denmark)

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

    2014-01-01

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

  18. Effect of PPCI at different time on the prognosis of patients with ST segment elevation myocardial infarction

    OpenAIRE

    Xue-yao FENG; Liu, Li; Jing-tao ZHAO; Song, Hong-Yong; Bei ZHAO; LIU, PEI-LIN; LIU, LI-FENG; Ying-qi LIU; Mao, Shuai; Zhou, Li; Hui-hui XIA; Tie-shan GAO; Shou-li WANG

    2016-01-01

    Objective  To analyze the influence of emergency direct percutaneous coronary intervention (PPCI) at different times on the prognosis of patients with ST segment elevation myocardial infarction (STEMI). Methods  The clinical data of two hundred twenty-three consecutive STEMI patients who were admitted to 306 Hospital of PLA from July 2011 to May 2014 receiving emergency PPCI within 12 hours of symptom onset were retrospectively studied. The patients were divided into three groups according to...

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

    OpenAIRE

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

    2016-01-01

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

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

    DEFF Research Database (Denmark)

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

    2010-01-01

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

  1. Comparison of hospital mortality during ST-segment elevation myocardial infarction in the era of reperfusion therapy in women versus men and in older versus younger patients.

    Science.gov (United States)

    Juliard, Jean-Michel; Golmard, Jean Louis; Himbert, Dominique; Feldman, Laurent J; Delorme, Laurent; Ducrocq, Gregory; Descoutures, Fleur; Sorbets, Emmanuel; Garbarz, Eric; Boudvillain, Olivier; Aubry, Pierre; Vahanian, Alec; Steg, Philippe Gabriel

    2013-06-15

    There is intense interest in examining hospital mortality in relation to gender in ST-segment elevation myocardial infarction. The aim of the present study was to determine whether gender influences outcomes in men and women treated with the same patency-oriented reperfusion strategy. The influence of gender on hospital mortality was tested using multivariate analysis and local regression. The influence of age was tested as a continuous and as a categorical variable. In the overall population of 2,600 consecutive patients, gender was not correlated with hospital mortality except in the subgroup of women aged ≥65 years. The risk for death increased linearly in logit scale for men. Up to the age of 65 years, the risk also increased linearly in women but thereafter increased faster than in men. Testing age as a categorical variable, hospital mortality was higher in women than in men aged ≥75 years but was similar between the genders in the younger age categories. In conclusion, despite following an equal patency-oriented management strategy in men and women with ST-segment elevation myocardial infarctions, the risk for hospital death increased linearly with age but with an interaction between age and gender such that older women had an independent increase in hospital mortality. Longer time to presentation and worse baseline characteristics probably contributed to determine a high-risk subset but reinforce the need to apply, as recommended in the international guidelines in the management of patients with ST-segment elevation myocardial infarctions, the same strategy of acute reperfusion in men and women.

  2. Consideration of QRS complex in addition to ST-segment abnormalities in the estimated "risk region" during acute anterior myocardial infarction

    DEFF Research Database (Denmark)

    van Hellemond, Irene E. G.; Bouwmeester, Sjoerd; Olson, Charles W.;

    2011-01-01

    The myocardial area at risk (MaR) has been estimated in patients with acute myocardial infarction (AMI) by using ST segment-based electrocardiographic (ECG) methods. As the process from ischemia to infarction progresses, the ST-segment deviation is typically replaced by QRS abnormalities causing...... a falsely low estimated total MaR if determined by using ST segment-based methods. The purpose of this study was to investigate if consideration of the abnormalities in the QRS complex, in addition to those in the ST segment, provides a more accurate estimated total MaR during anterior AMI than...

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

    NARCIS (Netherlands)

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

    2016-01-01

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

  4. 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....

  5. Firebird sirolimus eluting stent versus bare mental stent in patients with ST-segment elevation myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    GAO Hai; YAN Hong-bing; ZHU Xiao-ling; LI Nan; AI Hui; WANG Jian; LI Shi-ying; YANG Duo

    2007-01-01

    Background There are few evidences about the value of drug eluting stent in patients with ST-segment elevation myocardial infarction (STEMI). We prospectively designed a randomized controlled trial to compare the safety and efficacy of Firebird sirolimus eluting stent (Firebird stent) and bare metal stent (BMS).Methods Patients with STEMI enrolled during one year period were randomized to undergo implantation of Firebird stent or BMS, and clinical and angiographic follow-up. The primary endpoint of the present study was in-lesion late lumen loss (LLL) at 6 months, and secondary endpoint includes stent thrombosis and major adverse cardiac events (MACE) at 6 months.Results During one year period, 156 patients were randomized into the Firebird stent group (101 patients with an average age of 57.8 years) or the BMS group (55 patients with 59.7 years on average). Six-month angiographic follow-up was available in 66.3% and 63.7% of patients assigned to Firebird stent and BMS, respectively. At 6-month follow-up,mortality, target vessel revascularization (TVR) and MACE were 2.0%, 6.9% and 9.9% in the Firebird stent group, while 3.6%, 30.9% and 36.4% in the BMS group (P<0.05). Subacute thrombosis occurred in 1 patient in both groups,respectively. The mean LLL was 0.18 mm in the Firebird stent group versus 0.72 mm in the BMS group.Conclusion Implantation of Firebird sirolimus eluting stent for STEMI may greatly reduce TVR and MACE at 6 months with low incidence of acute/subacute stent thrombosis compared with BMS.

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

    DEFF Research Database (Denmark)

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

    2009-01-01

    myocardial infarction; however, its prognostic significance may be limited to patients treated with fibrinolysis. METHODS: In the DANAMI-2 (DANish trial in Acute Myocardial Infarction-2) substudy, including 1,421 patients, the ST-segment elevation at baseline, pre-intervention, 90 min, and 4 h was assessed...

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

    Institute of Scientific and Technical Information of China (English)

    刘志; 华琦; 谭静

    2012-01-01

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

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

    Science.gov (United States)

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

    2016-09-01

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

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

    Institute of Scientific and Technical Information of China (English)

    张勇; 唐海沁; 李瑾

    2012-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    王书鹏; 秦历杰

    2013-01-01

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

  11. 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.

  12. 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

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

    Institute of Scientific and Technical Information of China (English)

    郭瑞威; 杨丽霞; 齐峰; 陈长征

    2014-01-01

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

  14. 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

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

    Institute of Scientific and Technical Information of China (English)

    贺铿; 石刚; 赵勇; 叶君明

    2013-01-01

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

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

    International Nuclear Information System (INIS)

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

  17. [Role of the SYNTAX score in assessing the outcomes of percutaneous interventions in patients with ST segment elevation myocardial infarction].

    Science.gov (United States)

    Tarasov, R S; Ganyukov, V I; Barbarash, O L; Barbarash, L S

    2016-01-01

    Based on the findings of a single-centre study of 327 patients presenting with ST segment elevation myocardial infarction (STEMI) subjected to primary percutaneous coronary intervention (PCI) we examined the prognostic role of severity of atherosclerotic multivascular lesion (ML) of the coronary bed. The patients were subdivided into three groups depending on the quantitative index assessing severity of coronary atherosclerosis in points with the help of the SYNTAX scale. Group One was composed of 207 patients with the SYNTAX score≤22 points (moderate lesion), Group Two comprised 89 patients with severe coronary atherosclerosis and the SYNTAX equalling 23-32 points, whereas 31 patients were included into Group Three with extremely severe lesion and the SYNTAX score>32 points. During 30 days and 12 months of follow up we assessed the effect of severity of coronary atherosclerosis on the outcomes of myocardial revascularization. The end points of the study were such unfavourable cardiovascular events as death, recurrent myocardial infarction (MI), secondary unplanned revascularization (SUR) of coronary arteries and in-stent thrombosis (IST). We obtained the findings suggesting that severity of the lesion of the coronary bed according to the SYNTAX scale>23 is associated with a decrease in the global myocardial contractility, increased incidence of postinfarction cardiosclerosis (PICS) and more pronounced manifestation of acute left ventricular insufficiency as compared to patients with moderately pronounced coronary atherosclerosis (SYNTAXSYNTAX score was evidenced both at the stage of the 30-day and 12-month period of follow up, which manifested itself in a considerable increase of frequency of fatal outcomes, in-stent thrombosis and the composite end point amongst patients with severity of the coronary bed lesion by the SYNTAX score>23 points. Thus, the SYNTAX scale developed and adapted for optimal choice of the method of revascularization in patients with

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    唐聚花; 李莉

    2015-01-01

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

  20. The impact of numeric and graphic displays of ST-segment deviation levels on cardiologists' decisions of reperfusion therapy for patients with acute coronary occlusion.

    Science.gov (United States)

    Nimmermark, Magnus O; Wang, John J; Maynard, Charles; Cohen, Mauricio; Gilcrist, Ian; Heitner, John; Hudson, Michael; Palmeri, Sebastian; Wagner, Galen S; Pahlm, Olle

    2011-01-01

    The study purpose is to determine whether numeric and/or graphic ST measurements added to the display of the 12-lead electrocardiogram (ECG) would influence cardiologists' decision to provide myocardial reperfusion therapy. Twenty ECGs with borderline ST-segment deviation during elective percutaneous coronary intervention and 10 controls before balloon inflation were included. Only 5 of the 20 ECGs during coronary balloon occlusion met the 2007 American Heart Association guidelines for ST-elevation myocardial infarction (STEMI). Fifteen cardiologists read 4 sets of these ECGs as the basis for a "yes/no" reperfusion therapy decision. Sets 1 and 4 were the same 12-lead ECGs alone. Set 2 also included numeric ST-segment measurements, and set 3 included both numeric and graphically displayed ST measurements ("ST Maps"). The mean (range) positive reperfusion decisions were 10.6 (2-15), 11.4 (1-19), 9.7 (2-14), and 10.7 (1-15) for sets 1 to 4, respectively. The accuracies of the observers for the 5 STEMI ECGs were 67%, 69%, and 77% for the standard format, the ST numeric format, and the ST graphic format, respectively. The improved detection rate (77% vs 67%) with addition of both numeric and graphic displays did achieve statistical significance (P numeric and/or graphic displays. Acute coronary occlusion detection rate was low for ECGs meeting STEMI criteria, and this was improved by adding ST-segment measurements in numeric and graphic forms. These results merit further study of the clinical value of this technique for improved acute coronary occlusion treatment decision support.

  1. Regional Longitudinal Myocardial Deformation Provides Incremental Prognostic Information in Patients with ST-Segment Elevation Myocardial Infarction

    DEFF Research Database (Denmark)

    Biering-Sørensen, Tor; Jensen, Jan Skov; Pedersen, Sune H;

    2016-01-01

    BACKGROUND: Global longitudinal systolic strain (GLS) has recently been demonstrated to be a superior prognosticator to conventional echocardiographic measures in patients after myocardial infarction (MI). The aim of this study was to evaluate the prognostic value of regional longitudinal...... myocardial deformation in comparison to GLS, conventional echocardiography and clinical information. METHOD: In total 391 patients were admitted with ST-Segment elevation myocardial infarction (STEMI), treated with primary percutaneous coronary intervention and subsequently examined by echocardiography. All...... patients were examined by tissue Doppler imaging (TDI) and two-dimensional strain echocardiography (2DSE). RESULTS: During a median-follow-up of 5.3 (IQR 2.5-6.1) years the primary endpoint (death, heart failure or a new MI) was reached by 145 (38.9%) patients. After adjustment for significant confounders...

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  3. 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...

  4. Pre-infarction angina and outcomes in non-ST-segment elevation myocardial infarction: data from the RICO survey.

    Directory of Open Access Journals (Sweden)

    Luc Lorgis

    Full Text Available BACKGROUND: The presence of pre-infarction angina (PIA has been shown to confer cardioprotection after ST-segment elevation myocardial infarction (STEMI. However, the clinical impact of PIA in non-ST-segment elevation myocardial infarction (NSTEMI remains to be determined. METHODS AND RESULTS: From the obseRvatoire des Infarctus de Côte d'Or (RICO survey, 1541 consecutive patients admitted in intensive care unit with a first NSTEMI were included. Patients who experienced chest pain <7 days before the episode leading to admission were defined as having PIA and were compared with patients without PIA. Incidence of in-hospital ventricular arrhythmias (VAs, heart failure and 30-day mortality were collected. Among the 1541 patients included in the study, 693 (45% patients presented PIA. PIA was associated with a lower creatine kinase peak, as a reflection of infarct size (231(109-520 vs. 322(148-844 IU/L, p<0.001 when compared with the group without PIA. Patients with PIA developed fewer VAs, by 3 fold (1.6% vs. 4.0%, p = 0.008 and heart failure (18.0% vs. 22.4%, p = 0.040 during the hospital stay. Overall, there was a decrease in early CV events by 26% in patients with PIA (19.2% vs. 25.9%, p = 0.002. By multivariate analysis, PIA remained independently associated with less VAs. CONCLUSION: From this large contemporary prospective study, our work showed that PIA is very frequent in patients admitted for a first NSTEMI, and is associated with a better prognosis, including reduced infarct size and in hospital VAs. Accordingly, protecting the myocardium by ischemic or pharmacological conditioning not only in STEMI, but in all type of MI merits further attention.

  5. Consideration of QRS complex in addition to ST-segment abnormalities in the estimation of the "risk region" during acute anterior or inferior myocardial infarction.

    Science.gov (United States)

    Vervaat, F E; Bouwmeester, S; van Hellemond, I E G; Wagner, G S; Gorgels, A P M

    2014-01-01

    The myocardial area at risk (MaR) is an important aspect in acute ST-elevation myocardial infarction (STEMI). It represents the myocardium at the onset of the STEMI that is ischemic and could become infarcted if no reperfusion occurs. The MaR, therefore, has clinical value because it gives an indication of the amount of myocardium that could potentially be salvaged by rapid reperfusion therapy. The most validated method for measuring the MaR is (99m)Tc-sestamibi SPECT, but this technique is not easily applied in the clinical setting. Another method that can be used for measuring the MaR is the standard ECG-based scoring system, Aldrich ST score, which is more easily applied. This ECG-based scoring system can be used to estimate the extent of acute ischemia for anterior or inferior left ventricular locations, by considering quantitative changes in the ST-segment. Deviations in the ST-segment baseline that occur following an acute coronary occlusion represent the ischemic changes in the transmurally ischemic myocardium. In most instances however, the ECG is not available at the very first moments of STEMI and as times passes the ischemic myocardium becomes necrotic with regression of the ST-segment deviation along with progressive changes of the QRS complex. Thus over the time course of the acute event, the Aldrich ST score would be expected to progressively underestimate the MaR, as was seen in studies with SPECT as gold standard; anterior STEMI (r=0.21, p=0.32) and inferior STEMI (r=0.17, p=0.36). Another standard ECG-based scoring system is the Selvester QRS score, which can be used to estimate the final infarct size by considering the quantitative changes in the QRS complex. Therefore, additional consideration of the Selvester QRS score in the acute phase could potentially provide the "component" of infarcted myocardium that is missing when the Aldrich ST score alone is used to determine the MaR in the acute phase, as was seen in studies with SPECT as gold

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

    Institute of Scientific and Technical Information of China (English)

    曾汇庆; 郑海生

    2010-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Sharmini Selvarajah

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

  8. The influence of different dose of statins on postoperative renal function in patients with acute non-ST segment elevation myocardial infarction%不同剂量他汀对急性非ST段抬高心肌梗死患者介入术后肾功能的影响

    Institute of Scientific and Technical Information of China (English)

    段娜; 侯爱洁; 李占全

    2015-01-01

    Objective To evaluate the influence of different dose of statins on postoperative renal function in patients with acute non-ST segment elevation myocardial infarction. Methods 116 patients diagnosed as acute non-ST segment elevation myocardial infarction in our hospital heart center from December 2010 to November 2010 were selected,and all patients were agreed to undergo interventional examination and treatment.116 patients were randomly divided into 20 mg normal dose group and 40 mg strengthened dose group.All patients were given with atorvastatin calcium tablet oral before going to sleep.After three days of standard drug therapy,they were undergone interventional examination and treatment.All patients wre drew blood on preoperative and postoperative 24 hours,48 hours for the test of creatinine (SCr),urea nitrogen (BUN),cystatinC (Cys C) and C-reactive protein (CRP).According to the test results calculated the endogenous creatinine clearance (CCr). Results Compared with strengthened dose group,the Cys C level of the normal dose group at postoperative 24 hours was hihger (P<0.05),CCr was lower (P<0.05).Compared with preoperative level,Cys C level of normal dose group at postoperative 24 hours was higher (P<0.05). Conclusion Interventional examination and treatment with the contrast medium can lead to glomerular filtration function damage.The larger dose of statins can more effectively improve the kidney function.Application of 40 mg atorvastatin can be more effective prevented the happening of the CI-AKI than 20 mg atorvastatin.%目的:评价不同剂量阿托伐他汀对急性非ST段抬高心肌梗死患者介入术后肾功能的影响。方法选取2010年12月~2013年11月本院心脏中心明确诊断为急性非ST段抬高心肌梗死,并同意行介入检查及治疗的患者共116例,将其随机分为20 mg常规剂量组及40 mg强化剂量组,所有患者均睡前给予阿托伐他汀钙片口服,在给予药物规范化治疗3 d后行介入检查及

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

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    HamidReza Sanati

    2015-10-01

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

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

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    Pilar Portero Pérez

    2012-07-01

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

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

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    段雯婷

    2014-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    覃秀川; 王春梅; 索旻; 穆希娟; 文勃

    2013-01-01

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

  13. Impact of Pretreatment With Clopidogrel on Initial Patency and Outcome in Patients Treated With Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction A Systematic Review

    NARCIS (Netherlands)

    Vlaar, Pieter J.; Svilaas, Tone; Damman, Kevin; de Smet, Bart J. G. L.; Tijssen, Jan G. P.; Hillege, Hans L.; Zijlstra, Felix

    2008-01-01

    Background-The main goal of the initial treatment of ST-segment elevation myocardial infarction is prompt reperfusion of the infarct-related artery. The value of pretreatment with clopidogrel before primary percutaneous coronary intervention is currently unclear. Methods and Results-Studies were ret

  14. Relation of hyperglycemia to ST-segment resolution after primary percutaneous coronary intervention for acute myocardial infarction

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    CHI Hong-jie; ZHANG Da-peng; XU Yuan; YANG Zhong-su; WANG Le-feng; CUI Liang; YANG Xin-chun

    2007-01-01

    Background Hyperglycemia has been shown to be a powerful predictor of poor outcome after ST-segment elevation myocardial infarotion (STEMI). This study aimed to evaluate the effect of admission glucose on microvascular flow after successful primary percutaneous coronary intervention (PCI) in patients with STEMI.Methods Successful primary PCI was performed in 267 patients with STEMI. The maximum ST elevation of single electrocardiogram (ECG) lead before and 60 minutes after PCI was measured, and patients were then divided into 3 groups according to the degree of ST-segment resolution (STR): absent (<30%), partial (30% to 70%) or complete(≥7o%).Results Of the 267 patients, 48 (18.0%) had absent STR, 137 (51.3%) experienced partial STR, and 82 (30.7%) had complete STR. The degree of STR decreased with increasing admission glucose levels (P=0.032), and patients with hyperglycemia (serum glucose level ≥11 mmol/L) were more likely to have absent STR (P=0.001). Moreover,hyperglycemia was an independent predictor of incomplete STR (odds ratio, 1.870; 95% confidence interval, 1.038 to 3.371, P=0.037).Conclusions Hyperglycemia on admission is associated with abnormal coronary microvascular reperfusion in patients with STEMI after successful primary PCI, which may contribute, at least in part, to the poor outcomes in these patients.

  15. 非ST段抬高型急性冠状动脉综合征患者血清胱抑素C与SYNTAX评分的相关性研究%Relationship between serum cystatin C level and SYNTAX score in patients with non-ST segment elevation acute coronary syndrome

    Institute of Scientific and Technical Information of China (English)

    王林; 袁国裕; 陈国雄; 陈士良

    2016-01-01

    Objective To evaluate the relationship between serum cystatin C level and the severity of coronary lesion in patients with non- ST segment elevation acute coronary syndrome (NSTE- ACS). Methods 202 patients with NSTE- ACS underwent coronary angiography (CAG) and were divided into unstable angina pectoris (UAP) group(n=124) and non- ST segment elevation myocardial infarction (NSTEMI) group (n=78). 54 persons with negative result of CAG served as control group. According to SYNTAX score, NSTE- ACS patients were divided into low- risk group(1~22scores, n=69), intermediate- risk group (23~32scores, n=92) and high- risk group (>32scores, n=41). Serum cystatin C was measured before CAG and compared between groups. The relation between serum cystatin C and SYNTAX score was determined. Results The serum cystatin C level was significantly higher in UAP group and NSTEMI group than in control group, and significantly higher in the intermediate- and high- risk groups than in the low- risk group. The Pearson correlation analysis showed that SYNTAX score was positively correlated to serum cystatin C level (r=0.78, P32 (P<0.01, P<0.05). Conclusion The level of serum cystatin C may be used to predict SYNTAX score in patients with NSTE- ACS.%目的:探讨非ST段抬高型急性冠状动脉综合征(NSTE- ACS)患者血清胱抑素C(CysC)水平与冠状动脉病变严重程度的关系。方法选择行冠状动脉造影的NSTE- ACS患者202例,分为不稳定性心绞痛(UAP组)124例,非ST段抬高型心肌梗死(NSTEMI组)78例,54例冠状动脉造影阴性的患者为对照组。将NSTE- ACS患者根据冠状动脉造影结果分为(SYNTAX)评分低分组(1~22分)69例、中分组(23~32分)92例、高分组(>32分)41例。所有患者冠状动脉造影前均检测血清CysC,比较各组的CysC水平并分析CysC与SYNTAX评分的相关性。结果 UAP组、NSTEMI组患者CysC[(1.26±0.38)、(1.38±0.55)mg/L]高于对照组[(0

  16. Effect on Inflammatory Factors between Ticagrelor and Clopidogrel after Emergency PCI about Patients with Acute ST-segment Elevation Myocardial Infarction%替格瑞洛与氯吡格雷对急性STEMI患者急诊PCI术后炎症因子的影响

    Institute of Scientific and Technical Information of China (English)

    张阳阳; 陈魁

    2014-01-01

    To compare the effect on inflammatory factors between ticagrelor and clopidogrel after emergency PCI about patients with acute ST-segment elevation myocardial infarction (STEMI) ,we divide 176 cases of acute STEMI patients who were undergone emergency PCI into ticagrelor group (group A) 58 cases ,conventional clopidogrel group (group B) 58cases and strenghed clopidogrel group (group C) 60 patients .Inflammatory cytokines such as C-reactive protein (CRP) , interleukin-6 (IL-6) ,myeloperoxidase (MPO) and soluble CD40 (sCD40L) were measured before surgery and 12 hours ,7 days ,1 month ,3months ,6months after surgery ,compared the statistics of inflammatory factors at different time .The results showed the inflammatory factors levels of enhanced clopidogrel and ticagrelor group degrades more than conventional clopidogrel group (P 0 .05 ) , but there was no statistical significance . Thus the effect on inflammatory factors of ticagrelor is stronger than conventional clopidogrel ,but near to strenghed clopidogrel .%为比较替格瑞洛与氯吡格雷对急性 ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入术(PCI)术后炎症因子的影响,将176例急性STEMI且行急诊PCI术的患者分为替格瑞洛组(A组)58例、氯吡格雷常规组(B组)58例、氯吡格雷强化组(C组)60例,分别测定术前、术后12小时、术后7天、术后1个月、术后3个月、6个月时炎症因子C-反应蛋白(CRP)、白细胞介素-6(IL-6)、髓过氧物酶(MPO)、可溶性CD40受体(sCD40L)的含量,比较3组患者各炎症因子在不同时间点有无统计学差异。结果显示C组和A组较B组明显降低(P<0.05),有统计学意义,而A组较C组稍降低(P>0.05),但两者无统计学意义。由此可见,替格瑞洛的抗炎作用较常规剂量氯吡格雷作用明显增强,和强化剂量氯吡格雷作用相仿。

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

    Institute of Scientific and Technical Information of China (English)

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

    2010-01-01

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

  18. Clinical efficacy and safety of autologous stem cell transplantation for patients with ST-segment elevation myocardial infarction

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    Li R

    2016-08-01

    Full Text Available Rong Li,1,* Xiao-Ming Li,2,* Jun-Rong Chen,3 1Department of Intensive Care Unit, The People’s Hospital of Baoji City, 2Department of Cardiovascular Medicine, 3Department of Function, Baoji Central Hospital, Baoji, Shaanxi, People’s Republic of China *These authors contributed equally to this work Purpose: The purpose of this study is to evaluate the therapeutic efficacy and safety of stem cells for the treatment of patients with ST-segment elevation myocardial infarction (STEMI.Materials and methods: We performed a systematic review and meta-analysis of relevant published clinical studies. A computerized search was conducted for randomized controlled trials of stem cell therapy for STEMI.Results: Twenty-eight randomized controlled trials with a total of 1,938 STEMI patients were included in the present meta-analysis. Stem cell therapy resulted in an improvement in long-term (12 months left ventricular ejection fraction of 3.15% (95% confidence interval 1.01–5.29, P<0.01. The 3-month to 4-month, 6-month, and 12-month left ventricular end-systolic volume showed favorable results in the stem cell therapy group compared with the control group (P≤0.05. Significant decrease was also observed in left ventricular end-diastolic volume after 3-month to 4-month and 12-month follow-up compared with controls (P<0.05. Wall mean score index was reduced significantly in stem cell therapy group when compared with the control group at 6-month and 12-month follow-up (P=0.01. Moreover, our analysis showed a significant change of 12-month infarct size decrease in STEMI patients treated with stem cells compared with controls (P<0.01. In addition, no significant difference was found between treatment group and control in adverse reactions (P>0.05.Conclusion: Overall, stem cell therapy is efficacious in the treatment of patients with STEMI, with low rates of adverse events compared with control group patients. Keywords: ST-segment elevation myocardial

  19. 不同年龄ST段抬高型心肌梗死患者的临床及冠状动脉造影特点研究%Clinical and coronary angiographic characteristics of acute ST-segment elevation myocardial infarction in patients of different ages

    Institute of Scientific and Technical Information of China (English)

    陈启; 陈韬; 朱荔; 李文文; 刘宇; 陈亮; 马丽萍; 赵仙先

    2015-01-01

    目的:分析不同年龄急性ST段抬高型心肌梗死(STEMI)患者临床和冠状动脉造影特点。方法回顾分析在本院住院的STEMI患者的电子病历资料,比较青年组、中年组和老年组的危险因素、临床特点、实验室指标、心电图、冠状动脉造影结果及预后。结果共1354例STEMI患者,其中青年组68例,中年组413例,老年组873例。青年组男性患者、吸烟、冠心病家族史、Kil ipⅠ级所占比例以及甘油三酯和血小板水平较老年组患者高,而高血压、室性心动过速/心室颤动、新发心房颤动, Kil ip IV级较老年组低,差异均有统计学意义(P<0.05),青年组冠状动脉造影“正常”和单支病变所占比例较中年组和老年组高,而后壁心肌梗死和三支病变较低(均P<0.05)。青年组死亡、心肌再梗死和再次PCI的发生率低于中年组及老年组患者(均P<0.05)。结论急性STEMI的危险因素、临床情况、冠状动脉造影特点及预后青年与中年和老年患者有较大不同,应针对这些特点进行治疗。%Objective To analyze clinical and coronary angiographic features of ST- segment elevation myocardial infarction (STEMI) in patients of different ages. Methods The electric medical records of inpatients with STEMI from January 2007 to December 2013 in our hospital were reviewed. The risk factors,clincial characteristics, lab parameters, ECG, coronary angiography and prognosis were compared among young, middle- aged and elderly patients. Results 1354 inpatients with SETMI were enrolled. Of them, 68 cases were in young group, 413 cases in middle- aged group, and 873 cases in elderly group. Male, smoker, family history of coronary artery disease, Kil ip I, triglyceride and platelet count were significantly higher, while hypertension, ventricular tachycardia/fibril ation, new atrial fibrillation and Kil ip IV were lower in young group than elderly group (al P<0

  20. 急性大面积ST段抬高型心肌梗死患者早期床旁应用主动脉内气囊反搏术预后观察%Observation on the prognosis of early application of bedside intra-aortic balloon pump counterpulsation in patients with acute ST-segment elevation myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    李志娟; 李春燕; 董平栓; 杨旭明; 刘威; 王可; 李治国; 赵玉伟; 靳国青; 李转珍

    2012-01-01

    目的:研究急性大面积ST段抬高型心肌梗死(STEMI)患者在择期经皮冠状动脉介入治疗(PCI)前尽早床旁应用主动脉内气囊反搏术(IABP)对预后的观察.方法:选取发病12 ~72 h的STEMI患者150例,随机分为2组,IABP组72例,对照组78例,2组均给予规范的药物治疗,IABP组同时床旁应用IABP.2组均于发病10~14d行冠脉造影,必要时行PCI术,评价梗死相关血管PCI术前及术后冠脉血流,术后4周心功能、IABP主要不良心脏事件的发生情况.结果:2组患者PCI术前TIMI血流、PCI术后4周主要不良心脏事件的发生率、左心室射血分数(LVEF)均有显著性差异(P<0.05).结论:对于急性大面积STEMI患者择期行PCI,尽早床旁应用IABP能改善梗死相关血管的TIMI血流,改善心功能,减少主要不良心脏事件的发生率,临床应用安全可行.%Objective: To evaluate the effect of early application of intra-aortic balloon pump counterpulsation (IABP) on prognosis of patients with acute ST-segment elevation myocardial infarction (STEMI) before elective percutaneous coronary interventional (PCI). Methods; One hundred and fifty patients with STEMI were randomly divided into two groups: 72 patients in IABP group and 78 in control group. All patients in IABP group receiving bedside IABP support treatment while patients in control group do not. All patients were performed PCI after 10 to 14 days. The blood flow rate of infart related coronary vessel was observed before and after PCI. The major adverse cardiac events ( MACE) and heart function at 4 weeks were studied. Results; In IABP group, blood flow rate of related coronary vessel, the occurance of MACE at 4 weeks, left ventricle ejection fraction (LVEF) were significant different in two groups (P < 0. 05). Conclusions; Early application of IABP for patients with STEMI before elective PCI is safe and effective, which can reduce the incidence of MACE, and improve heart function.

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

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    Lei Zhang

    2015-01-01

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

  2. Adjunctive manual thrombus aspiration during ST-segment elevation myocardial infarction: a meta-analysis of randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Song-Bai Deng

    Full Text Available The aim of this study was to synthesize evidence by examining the effects of manual thrombus aspiration on clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI.A total of 26 randomized controlled trials (RCTs, enrolling 11,780 patients, with 5,869 patients randomized to manual thrombus aspiration and 5,911 patients randomized to conventional percutaneous coronary intervention (PCI, were included in the meta-analysis. Separate clinical outcome analyses were based on different follow-up periods. There were no statistically reductions in the incidences of mortality (risk ratio [RR], 0.86 [95% confidence interval [CI]: 0.73 to 1.02], reinfarction (RR, 0.62 [CI, 0.31 to 1.32] or target vessel revascularization (RR, 0.89 [CI, 0.75 to 1.05] in the manual thrombus aspiration arm at 12 to 24 months of follow-up. The composite major adverse cardiac events (MACEs outcomes were significantly lower in the manual thrombus aspiration arm over the long-term follow-up (RR, 0.76 [CI, 0.63 to 0.91]. A lower incidence of reinfarction was observed in the hospital to 30 days (RR, 0.59 [CI, 0.37 to 0.92].The present meta-analysis suggested that there was no evidence that using manual thrombus aspiration in patients with STEMI could provide distinct benefits in long-term clinical outcomes.

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

    Institute of Scientific and Technical Information of China (English)

    夏雪; 郑再星; 朱千里; 黄伟剑

    2015-01-01

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

  4. An unusual case of ST-segment elevation myocardial infarction following a late bare-metal stent fracture in a native coronary artery: a case report

    Directory of Open Access Journals (Sweden)

    Minardi Giovanni

    2009-11-01

    Full Text Available Abstract Introduction A bare-metal stent fracture as a cause of acute coronary thrombosis and consequently of acute coronary syndrome is a rare clinical event that, to the best of our knowledge, has previously not been reported. A stent fracture is a rare complication arising from percutaneous coronary intervention. Case presentation We present, to the best of our knowledge, the first documented case of ST-segment elevation myocardial infarction in a patient following a late bare-metal stent fracture and thrombosis in a native coronary artery. The patient, a 51-year-old Caucasian man, was treated successfully with primary percutaneous coronary intervention and a new stent implantation. Conclusion A coronary stent fracture is a rare complication that has been described in venous bypass grafts deploying either a drug-eluting stent or a bare-metal stent. Stent fractures rarely occur in coronary arteries. In light of the non-specific presentation of stent fracture, it is also an easily missed complication. Patients may present with a non-specific symptom of angina. The angina could either be stable or unstable as a result of restenosis or in-stent thrombosis, or both. Our case demonstrates the most severe consequences of a bare-metal stent fracture (sudden coronary thrombosis and subsequent myocardial infarction in a native coronary artery. It was diagnosed angiographically and treated early and effectively.

  5. Predictors of delayed pre-hospital presentation among patients with ST-segment elevation myocardial infarction

    Science.gov (United States)

    Albrahim, Mohammed; Ahmed, Amjad M.; Alwakeel, Abdulrahman; Hijji, Faisal; Al-Mallah, Mouaz H.

    2016-01-01

    Background: Early treatment of ST elevation myocardial infarction (STEMI) is essential to improve survival of these patients. However, not all patients present early enough to receive optimal treatment especially in third world countries. Social factors affecting early vs. late treatment have not been studied, particularly in the Middle East. Thus, the aim of this study was to determine the social factors associated with delayed presentation of STEMI patients. Methods: All patients with STEMI presenting to King Abdulaziz Cardiac Center (KACC) between October 2013 and July 2014 were approached. After obtaining consent, patients were interviewed regarding their psychosocial circumstances using a standardized questionnaire. Their medical charts were also reviewed for further clinical data. Patients were divided according to their symptom-to-door time into early ( ≤ 6h) and late (>6h) presentation and group comparisons were conducted. Results: A total of 79 patients were enrolled, of which 24 patients (30%) presented late. Patients with increased symptom-to-door time had higher prevalence of diabetes (40% vs. 79.2%, p = 0.001), hypertension (43.6% vs. 70.8%, p = 0.023), and dyslipidemia (23.6% vs. 54.2%, p = 0.009). Most of the late presenters did not undergo primary coronary intervention (72.7% vs. 47.8%, P = 0.034) and had less prior information about myocardial infarction (43.6% vs. 25%, P = 0.023). Late presenters were more often illiterates and lived most often far away from the hospital. Using multivariate logistic regression; dyslipidemia was the only independent predictor for the late hospital presentation for STEMI patients. Conclusion: One third of patients with STEMI present more than six hours after symptom onset; these patients have a higher prevalence of coronary risk factors and less information about STEMI. Programs should be designed to educate patients and the general public about the symptoms of STEMI and the necessary action to be

  6. ST segment elevation in lead aVR during exercise testing is associated with LAD stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Neill, Johanne; Harbinson, Mark [Royal Victoria Hospital, Regional Medical Cardiology Centre, Belfast (United Kingdom); Queens University, Belfast (United Kingdom); Shannon, Heather J.; Morton, Amanda; Muir, Alison R.; Adgey, Jennifer A. [Royal Victoria Hospital, Regional Medical Cardiology Centre, Belfast (United Kingdom)

    2007-03-15

    To evaluate, in patients with chest pain, the diagnostic value of ST elevation (STE) in lead aVR during stress testing prior to {sup 99m} Tc-sestamibi scanning correlating ischaemic territory with angiographic findings. Consecutive patients attending for {sup 99m} Tc-sestamibi myocardial perfusion imaging (MPI) completed a treadmill protocol. Peak exercise ECGs were coded. STE {>=}0.05 mV in lead aVR was considered significant. Gated perfusion images and findings at angiography were assessed. STE in lead aVR occurred in 25% (138/557) of the patients. More patients with STE in aVR had a reversible defect on imaging compared with those who had no STE in aVR (41%, 56/138 vs 27%, 114/419, p=0.003). Defects indicating a left anterior descending artery (LAD) culprit lesion were more common in the STE in aVR group (20%, 27/138 vs 9%, 39/419, p=0.001). There was a trend towards coronary artery stenosis (>70%) in a double vessel distribution involving the LAD in those patients who had STE in aVR compared with those who did not (22%, 8/37 vs 5%, 4/77, p=0.06). Logistic regression analysis demonstrated that STE in aVR (OR 1.36, p=0.233) is not an independent predictor of inducible abnormality when adjusted for STD >0.1 mV (OR 1.69, p=0.026). However, using anterior wall defect as an end-point, STE in aVR (OR 2.77, p=0.008) was a predictor even after adjustment for STD (OR 1.43, p=0.281). STE in lead aVR during exercise does not diagnose more inducible abnormalities than STD alone. However, unlike STD, which is not predictive of a territory of ischaemia, STE in aVR may indicate an anterior wall defect. (orig.)

  7. Primary percutaneous coronary intervention without on-site cardiac surgery backup in unselected patients with ST-segment-Elevation Myocardial Infarction: The RIvoli ST-segment Elevation Myocardial Infarction (RISTEMI) registry

    Energy Technology Data Exchange (ETDEWEB)

    Tomassini, Francesco, E-mail: tomascard.tomassini@gmail.com [Department of Cardiology, Infermi Hospital, Rivoli (Italy); Gagnor, Andrea; Montali, Nicolò; Infantino, Vincenzo; Tizzani, Emanuele; Tizzani, Paolo [Department of Cardiology, Infermi Hospital, Rivoli (Italy); Lanza, Gaetano Antonio [Institute of Cardiology, Catholic University, Rome (Italy); Conte, Maria Rosa; Varbella, Ferdinando [Department of Cardiology, Infermi Hospital, Rivoli (Italy)

    2013-01-15

    Background: Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for patients with ST-segment-elevation myocardial infarction (STEMI), but some concerns remain about its safety and efficacy in centers without on-site cardiac surgery (OCS). Methods: The Infermi Hospital in Rivoli, Italy, is a community hospital without OCS with a high volume catheterization laboratory (> 800 PCI and > 150 primary PCI per year), which provides a 24-hour primary PCI service to a population of 583.000 and is only 14 km far from the nearest OCS hospital. We analyzed clinical and procedural data, as well as 30-day outcome, of all STEMI patients treated by primary PCI within 12 hours from symptom onset. Results: From September 2001 to June 2010, 1302 patients with a suspect of STEMI underwent urgent coronary angiography. Of these, 1251 (96.1%), underwent primary PCI. A successful myocardial revascularization was achieved in 1172 patients (93.7%). Thirty-day mortality occurred in 7.1%. Multivariate predictors of 30-day mortality were: age ≥ 75 years (OR 3.96, p = 0.0003), left ventricular ejection fraction ≤ 40% (OR 35.0, p = 0.02), cardiogenic shock at presentation (OR 33.4, p < 0.0001), anterior STEMI (OR 1.82, p = 0.036) and total ischemic time ≤ 3 hours (OR 0.55, p = 0.05). Conclusions: Primary PCI is a reperfusion strategy feasible and effective in unselected high-risk STEMI patients even in hospitals without OCS with a high volume of routine and emergency interventional procedures.

  8. 急性ST段抬高心肌梗死患者应用急救医疗服务的影响因素%Factors Related to Use of Emergency Medical Services in Patients with Acute ST Segment Elevation Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    王璟; 郭金成

    2009-01-01

    Objective To explore the choice of transportation mode to hospital in patients experiencing acute ST elevation myocardial infarction(STEMI)and ascertain the factors that may influence the use of Emergency Medical Service(EMS)in patients with acute STEMI.Methods 412 consective patients confirmed STEMI from Febury 2006 to January 2009 were divided into two groups based on the use of EMS:EMS group and self-transportation group.A questionnaire developed to assess demographic characteristics,Clinical factors and psychological factors.Paients were interviewed within 72 hours of admission to 2 hospitals.Results EMS was used in 26.90% of patients with STEMI,actors associated with EMS in a univariate analysis were history of coronary artery disease hospitalization,nausea,vomiting,dizziness,collapse,sudden onset,progressive symptoms,"waited and see","worried about to bother others",times of contacting physician before arrived at study hospital,thinking it was a cardiac origin disease.In a multivariate analysis,contact physician(0.49,0.33~0.73),nausea (2.57,1.58~4.19),collapse(5.49,2.05~14.70),progressive symptoms(1.98,1.19~3.29),"waited and see" (0.55,0.34~0.89)and contributed symptoms to cardiac disease(2.37,1.44~3.91).Conclusion Only one fourth of patients with STEMI were transported to the hospital by EMS,they view the EMS as an option for transportation to hospital only if they feel really sick.For that reason,it needs to be made well known to the public that EMS are not only a mode of transport,but also provide diagnostics and treatment.%目的 探讨急性ST段抬高心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者到达医院时交通工具的选择类型及影响患者选择急救医疗服务(emergency medical service,EMS)的因素.方法 我院住院并确诊的412例STEMI患者,根据是否应用EMS到医院分为两组:EMS组和自我转运组.对比分析两组患者应用急救医疗服务的情况.结果 有26.90%的患者应

  9. Comparison of Diver CE and ZEEK manual aspiration catheters for thrombectomy in ST-segment elevation myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    ZHAO Han-jun; YAN Hong-bing; WANG Jian; SONG Li; LI Qing-xiang; LI Shi-ying; CHI Yun-peng; WU Zheng; ZHANG Xiao-jiang; ZHAO Yong; ZHENG Bin

    2009-01-01

    Background A growing volume of data suggests that simple manual thrombus aspiration followed by direct stenting improves myocardial reperfusion and clinical outcome compared with conventional primary PCI, but there is still limited data comparing the in vivo performance among different devices. This study aimed to compare the efficacy and operability of thrombus aspiration by the Diver CE (Invatec, Brescia, Italy) and ZEEK (Zeon Medical Inc., Tokyo, Japan) aspiration catheters in ST-segment elevation myocardial infarction (STEMI) and their impact on 3-month outcome.Methods From September 2004 to June 2008, 298 consecutive patients with STEMI who received manual thrombus aspiration were involved in a single center retrospective analysis. Of them, 229 and 69 were treated with Diver CE and ZEEK aspiration catheters, respectively. Primary endpoints were myocardial blush grade (MBG), thrombolysis in myocardial infarction (TIMI) flow grade, ST-segment elevation resolution (STR), device pushability and trackability as judged by the frequency of usage of dual guide wires and aspiration efficacy as indicated by size distribution of aspirated thrombi. Secondary endpoints were 3-month outcome including left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), as well as cardiac death, target lesion revascularization (TLR), re-infarction and their combination as major adverse cardiac events (MACE).Results Baseline characteristics were not different between the two groups expect for a higher frequency of temporary cardiac pacing in the ZEEK group (ZEEK) than in the Diver CE group (Diver CE) (0.44% vs 5.8%, P=0.002). Visible retrieved thrombi were achieved in 65.9% of the Diver CE and 68.1% of the ZEEK (P=0.74). Aspirated thrombi were categorized as small thrombi (7.0 mm). Small thrombi were more frequently seen in the Diver CE (61.6% vs 42.6%), whereas moderate and larger thrombi were more frequently found in the ZEEK (38.4% vs 57.4%) (P=0

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

    Institute of Scientific and Technical Information of China (English)

    李京宴; 玛依拉·吾甫尔; 时学昆; 陈凤辉; 程祖亨

    2013-01-01

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

  11. 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......-eluting stents (DES). Therefore, the aim of this study was to investigate sex-related differences in clinical outcome in patients with STEMI treated with primary angioplasty with Bare-Metal Stent (BMS) or DES.......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...

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

    Directory of Open Access Journals (Sweden)

    Kanka David

    2007-09-01

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

  13. Culprit vessel only versus multivessel percutaneous coronary intervention in patients presenting with ST-segment elevation myocardial infarction and multivessel disease.

    Directory of Open Access Journals (Sweden)

    Dongfeng Zhang

    Full Text Available BACKGROUND: The best strategy for ST-segment elevation myocardial infarction (STEMI patients with multivessel disease (MVD, who underwent primary percutaneous coronary intervention (PCI in the acute phase, is not well established. OBJECTIVES: Our goal was to conduct a meta-analysis comparing culprit vessel only percutaneous coronary intervention (culprit PCI with multivessel percutaneous coronary intervention (MV-PCI for treatment of patients with STEMI and MVD. METHODS: Pubmed, Elsevier, Embase, and China National Knowledge Infrastructure (CNKI databases were systematically searched for randomized and nonrandomized studies comparing culprit PCI and MV-PCI strategies during the index procedure. A meta-analysis was performed using Review Manager 5.1 (Cochrane Center, Denmark. RESULTS: Four randomized and fourteen nonrandomized studies involving 39,390 patients were included. MV-PCI strategy is associated with an increased short-term mortality (OR: 0.50, 95% CI: 0.32 to 0.77, p = 0.002, long-term mortality (OR: 0.52, 95% CI: 0.36 to 0.74, p<0.001, and risk of renal dysfunction (OR: 0.77, 95% CI: 0.61 to 0.97, p = 0.03 compared with culprit PCI strategy, while it reduced the incidence of revascularization (OR: 2.65, 95% CI: 1.80 to 3.90, p<0.001. CONCLUSIONS: This meta-analysis supports current guidelines which indicate that the non-culprit vessel should not be treated during the index procedure.

  14. Progressed Multivessel Spontaneous Coronary Artery Dissection That Naturally Healed in a Male Patient with Non-ST Segment Elevation Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Tatsuo Haraki

    2016-01-01

    Full Text Available Spontaneous coronary artery dissection (SCAD is a rare condition that may have a serious outcome because of acute coronary syndrome. The condition especially affects young women. We evaluated a middle-aged male patient with a non-ST segment elevation myocardial infarction caused by multivessel SCAD. The SCAD had occurred in the distal right coronary artery (RCA, the mid left anterior descending artery (LAD, and the distal LAD at the same time. His culprit lesion was in the distal RCA, but the SCAD had progressed more proximally within the RCA 12 days later with no clinical symptoms. We treated the mid LAD with implantation of a drug-eluting stent on admission and the SCAD had not progressed 12 days later. Moreover, the SCAD in the distal RCA and distal LAD healed spontaneously 12 days later. He had no recurrent attack, and all SCAD lesions of the RCA and LAD had completely healed 6 months later. Given that SCAD appears in various forms over the clinical course, a strategy of intervention needs careful consideration.

  15. Regional Longitudinal Myocardial Deformation Provides Incremental Prognostic Information in Patients with ST-Segment Elevation Myocardial Infarction.

    Directory of Open Access Journals (Sweden)

    Tor Biering-Sørensen

    Full Text Available Global longitudinal systolic strain (GLS has recently been demonstrated to be a superior prognosticator to conventional echocardiographic measures in patients after myocardial infarction (MI. The aim of this study was to evaluate the prognostic value of regional longitudinal myocardial deformation in comparison to GLS, conventional echocardiography and clinical information.In total 391 patients were admitted with ST-Segment elevation myocardial infarction (STEMI, treated with primary percutaneous coronary intervention and subsequently examined by echocardiography. All patients were examined by tissue Doppler imaging (TDI and two-dimensional strain echocardiography (2DSE.During a median-follow-up of 5.3 (IQR 2.5-6.1 years the primary endpoint (death, heart failure or a new MI was reached by 145 (38.9% patients. After adjustment for significant confounders (including conventional echocardiographic parameters and culprit lesion, reduced longitudinal performance in the anterior septal and inferior myocardial regions (but not GLS remained independent predictors of the combined outcome. Furthermore, inferior myocardial longitudinal deformation provided incremental prognostic 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<0.05 for all deformation parameters.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 echocardiographic risk factors. Furthermore, impaired longitudinal deformation outside the culprit lesion perfusion region seems to be a paramount marker of adverse outcome.

  16. Clinical predictors and outcomes of patients with left ventricular thrombus following ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Garber, Adam M; Mentz, Robert J; Al-Khalidi, Hussein R; Shaw, Linda K; Fiuzat, Mona; O'Connor, Christopher M; Velazquez, Eric J

    2016-04-01

    We aimed to characterize the independent predictors of LVT following STEMI and the association with outcomes. The clinical predictors of left ventricular thrombus (LVT) formation after ST-segment elevation myocardial infarction (STEMI) are not well-defined in the contemporary era. We performed a retrospective analysis of STEMI patients at Duke from 2000 to 2011 who had a transthoracic echocardiogram within 90 days post-STEMI and compared patients with and without LVT (LVT+ vs. LVT-). Univariate Cox proportional hazards regression models of baseline characteristics were examined and significant variables were used in a multivariable model to assess adjusted relationships with LVT. A multivariable Cox PH survival model with covariate adjustments was used for assessment of LVT and long-term mortality. Of all eligible patients, 1734 patients met inclusion criteria and 4.3 % (N = 74) had a LVT. LVT+ patients tended to have a history of heart failure (HF) and higher initial troponin compared to LVT- patients. After adjustment, higher heart rate, non-white race, HF severity, and presence of left anterior descending artery (LAD) disease were independent predictors of LVT. There was a trend toward an association between LVT and increased all-cause mortality (HR 1.36; 95 % CI 0.84-2.21, P = 0.22), however this was not statistically significant. LVT was seen in over 4 % of this contemporary post-STEMI population. Several baseline characteristics were independently associated with LVT: Heart rate, HF severity, LAD disease, and non-white race. Prospective studies are warranted to determine whether anticoagulation in patients at increased risk for LVT improves outcomes.

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

    Science.gov (United States)

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

    2016-01-01

    Objective It remains unknown whether complete revascularisation is optimally performed in patients with ST segment elevation myocardial infarction (STEMI) during the index or at staged procedures. The aims of this study were to quantify the number of primary percutaneous coronary intervention (PCI) procedures in which non-culprit lesions needed further evaluation, to determine the consequence of the re-evaluation and to quantify adverse cardiac events during the waiting time for re-evaluation and intervention. Methods The study was observational and retrospective and included all patients with STEMI treated with primary PCI during 1 year at our centre. Results Among the 507 patients with STEMI, 374 were considered sufficiently treated with culprit lesion PCI only. Complete primary multivessel revascularisation was performed in 11 patients. Non-culprit lesion re-evaluation was planned for 122 patients (24%). Of these 122 patients, 3 patients died during their index admission. Follow-up data were not available for 3 patients. Among the 116 patients, 187 non-culprit lesions were re-evaluated and 77 patients (66.4%) underwent revascularisation with treatment of 119 lesions (63.3%). Re-evaluation was performed after a median of 30 days (25th centile: 9 days, 75th centile: 35 days). During the waiting time for re-evaluation, two patients underwent a new primary PCI due to stent thrombosis of the index culprit lesion. Conclusions Staged re-evaluation of non-culprit lesions observed in patients with STEMI was required in 24% of a primary PCI cohort. Intervention was performed in 66.4% of patients scheduled for re-evaluation. We observed no adverse events related to the non-culprit lesions during the waiting time for a staged re-evaluation or intervention. PMID:27403331

  18. Importance of tissue perfusion in ST segment elevation myocardial infarction patients undergoing reperfusion strategies: role of adenosine.

    Science.gov (United States)

    Forman, Mervyn B; Jackson, Edwin K

    2007-11-01

    High risk ST segment elevation myocardial infarction (STEMI) patients undergoing reperfusion therapy continue to exhibit significant morbidity and mortality due in part to myocardial reperfusion injury. Importantly, preclinical studies demonstrate that progressive microcirculatory failure (the "no-reflow" phenomenon) contributes significantly to myocardial reperfusion injury. Diagnostic techniques to measure tissue perfusion have validated this concept in humans, and it is now clear that abnormal tissue perfusion occurs frequently in STEMI patients undergoing reperfusion therapy. Moreover, because tissue perfusion correlates poorly with epicardial blood flow (TIMI flow grade), clinical studies show that tissue perfusion is an independent predictor of early and late mortality in STEMI patients and is associated with infarct size, ventricular function, CHF and ventricular arrhythmias. The mechanisms responsible for abnormal tissue perfusion are multifactorial and include both mechanical obstruction and vasoconstrictor humoral factors. Adenosine, an endogenous nucleoside, maintains microcirculatory flow following reperfusion by activating four well-characterized extracellular receptors. Because activation of adenosine receptors attenuates the mechanical and functional mechanisms leading to the "no reflow" phenomenon and activates other cardioprotective pathways as well, it is not surprising that both experimental and clinical studies show striking myocardial salvage with intravenous infusions of adenosine administered in the peri-reperfusion period. For example, a post hoc analysis of the AMISTAD II trial indicates a significant reduction in 1 and 6-month mortality in STEMI patients undergoing reperfusion therapy who are treated with adenosine within 3 hours of symptoms. In conclusion, adenosine's numerous cardioprotective effects, including attenuation of the "no-reflow" phenomenon, support its use in high risk STEMI undergoing reperfusion. PMID:18000974

  19. Clinical effect of selective thrombus aspiration during primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Hai-wei LIU

    2015-06-01

    Full Text Available Objective To assess impact of selective thrombus aspiration (TA during primary percutaneous coronary intervention (pPCI on long-term prognosis in patients with ST-segment elevation myocardial infarction (STEMI. Methods  Between Jan. 2008 and Jan. 2014, a total of 2357 STEMI patients [429 in thrombus aspiration (TA group and 1928 in routine percutaneous coronsry intorventim (PCI group (control group] were eligible for the study criteria and candidates for pPCI were enrolled in this study. The reflow of the involved vessel in pPCI procedure, stent thrombosis and major adverse cardiac events (MACE were comparatively analyzed in the two groups during hospital stay and 12-month follow-up period. Results Although the success rate of TA procedure was significantly lower in TA group compared with that in control group (P<0.001, both the TIMI flow grade ≥2 after TA procedure and stent implantation occurred more frequently in TA group than in control group (P<0.05. The rates of MACE and stent thrombosis showed no difference between two groups during in-hospital and 12-month follow-up period (P>0.05. But the rates of total MACE and target vessel revascularization were significantly higher in control group than in TA group (P=0.04. Conclusion Selective TA procedure before primary PCI could improve final myocardial reperfusion, reduce the incidence of MACE and improve the 1-year clinical result for STEMI patients. DOI: 10.11855/j.issn.0577-7402.2015.04.04

  20. A novel predictor of infarct-related artery patency before percutaneous intervention and in-hospital outcomes for ST-segment elevation myocardial infarction patients: serum bilirubin level

    OpenAIRE

    Acet, Halit; Ertş, Faruk; Akıl, Mehmet Ata; Polat, Nihat; Aydın, Mesut; Akyüz, Abdurrahman; Ayçiçek, Hilal; Alan, Sait

    2014-01-01

    Introduction Previous studies have reported a relationship between serum bilirubin levels and coronary artery disease (CAD). However, data are rare up to now regarding the relation of bilirubin levels with infarct-related artery (IRA) patency in the setting of ST-segment elevation myocardial infarction (STEMI). Moreover, previous studies reported that increased bilirubin was related to impaired post-intervention coronary flow. To our knowledge, the association between serum total bilirubin (T...

  1. Culprit vessel only versus “one-week” staged percutaneous coronary intervention for multivessel disease in patients presenting with ST-segment elevation myocardial infarction

    OpenAIRE

    Ma, Li-Xiang; Lu, Zhen-Hua; Wang, Le; Du, Xin; Ma, Chang-Sheng

    2015-01-01

    Objective To explore the impact of a “one-week” staged multivessel percutaneous coronary intervention (PCI) versus culprit-only PCI on deaths and major adverse cardiac events (MACE). Methods We retrospectively analyzed 447 patients with multivessel disease who experienced a ST-segment elevation myocardial infarction (STEMI) within 12 h before undergoing PCI between July 26, 2008 and September 25, 2011. After completion of PCI in the infarct artery, 201 patients still in the hospital agreed to...

  2. Impact of renal insufficiency on mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Sabroe, Jonas Emil; Thayssen, Per; Antonsen, Lisbeth;

    2014-01-01

    BACKGROUND: Chronic kidney disease is associated with increased risk of mortality. We examined the impact of moderate and severe renal insufficiency (RI) on short- and long-term mortality among unselected patients with ST-segment elevation myocardial infarction (STEMI) treated with primary......-year all-cause mortality was 13.4% vs. 47.4% (log-rank p renal function (CrCl ≤30

  3. System Dynamics Modeling in the Evaluation of Delays of Care in ST-Segment Elevation Myocardial Infarction Patients within a Tiered Health System

    OpenAIRE

    Luciano de Andrade; Catherine Lynch; Elias Carvalho; Clarissa Garcia Rodrigues; João Ricardo Nickenig Vissoci; Guttenberg Ferreira Passos; Ricardo Pietrobon; Oscar Kenji Nihei; Maria Dalva de Barros Carvalho

    2014-01-01

    Background Mortality rates amongst ST segment elevation myocardial infarction (STEMI) patients remain high, especially in developing countries. The aim of this study was to evaluate the factors related with delays in the treatment of STEMI patients to support a strategic plan toward structural and personnel modifications in a primary hospital aligning its process with international guidelines. Methods and Findings The study was conducted in a primary hospital localized in Foz do Iguaçu, Brazi...

  4. Doppler Tissue Imaging Is an Independent Predictor of Outcome in Patients with ST-Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

    DEFF Research Database (Denmark)

    Biering-Sørensen, Tor; Jensen, Jan Skov; Pedersen, Sune;

    2014-01-01

    BACKGROUND: Doppler tissue imaging (DTI) detects early signs of left ventricular (LV) dysfunction; however, the prognostic significance of DTI after ST-segment elevation myocardial infarction (STEMI) is unknown. The aim of this study was to evaluate the prognostic value of DTI after STEMI......% confidence interval, 1.64-4.13; P gender, peak troponin I, previous myocardial infarction, LV ejection fraction, LV mass index, and LV dimension in a multivariate Cox model, patients...

  5. Percutaneous Coronary Intervention after Fibrinolysis for ST-Segment Elevation Myocardial Infarction Patients: An Updated Systematic Review and Meta-Analysis

    OpenAIRE

    Feng Liu; Qinglong Guo; Guoqiang Xie; Han Zhang; Yaxi Wu; Lixia Yang

    2015-01-01

    Background Percutaneous coronary intervention (PCI), fibrinolysis and the combination of both methods are current therapeutic options for patients with ST-segment elevation myocardial infarction (STEMI). Methods We searched PubMed, EMBASE, Google scholar and Cochrane Controlled Trials Register for randomized controlled trials (RCTs) evaluating the efficacy and safety of PCI after fibrinolysis within 24 hours, which was compared with primary PCI alone and ischemia-guided or delayed PCI. Meta-a...

  6. Age-related differences in treatment strategies and clinical outcomes in unselected cohort of patients with ST-segment elevation myocardial infarction transferred for primary angioplasty

    OpenAIRE

    Dziewierz, Artur; Siudak, Zbigniew; Rakowski, Tomasz; Dubiel, Jacek S.; Dudek, Dariusz

    2012-01-01

    Data concerning the benefits and risks of primary PCI in the elderly patients presenting with ST-segment elevation myocardial infarction (STEMI) are limited. Thus, the objective of the study was to assess age-dependent differences in the treatment and outcomes of STEMI patients transferred for primary PCI. Data were gathered on 1,650 consecutive STEMI patients from hospital networks in seven countries of Europe from November 2005 to January 2007 (the EUROTRANSFER Registry population). Patient...

  7. Effects of High-dose Atorvastatin Pretreatment in Patients with ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: A Cardiac Magnetic Resonance Study

    OpenAIRE

    Kim, Eun Kyoung; Hahn, Joo-Yong; Song, Young Bin; Chang, Sung-A; Choi, Jin-Ho; Choi, Seung-Hyuk; Lee, Sang-Chol; Choe, Yeon Hyeon; Lee, Sang Hoon; Gwon, Hyeon-Cheol

    2015-01-01

    It is uncertain that atorvastatin pretreatment can reduce myocardial damage in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). The aim of this study was to investigate the effects of atorvastatin pretreatment on infarct size measured by contrast-enhanced magnetic resonance imaging (CE-MRI) in STEMI patients. Patients undergoing primary PCI for STEMI within 12 hr after symptom onset were randomized to an atorvastatin ...

  8. D-Dimer Levels Predict Myocardial Injury in ST-Segment Elevation Myocardial Infarction: A Cardiac Magnetic Resonance Imaging Study

    Science.gov (United States)

    Song, Young Bin; Lima, Joao A. C.; Guallar, Eliseo; Choe, Yeon Hyeon; Hwang, Jin Kyung; Kim, Eun Kyoung; Yang, Jeong Hoon; Hahn, Joo-Yong; Choi, Seung-Hyuk; Lee, Sang-Chol; Lee, Sang Hoon; Gwon, Hyeon-Cheol

    2016-01-01

    Objectives Elevated D-dimer levels on admission predict prognosis in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI), but the association of D-dimer levels with structural markers of myocardial injury in these patients is unknown. Methods We performed cardiac magnetic resonance (CMR) imaging in 208 patients treated with primary PCI for STEMI. CMR was performed a median of 3 days after the index procedure. Of the 208 patients studied, 75 patients had D-dimer levels above the normal range on admission (>0.5 μg/mL; high D-dimer group) while 133 had normal levels (≤0.5 μg/mL; low D-dimer group). The primary outcome was myocardial infarct size assessed by CMR. Secondary outcomes included area at risk (AAR), microvascular obstruction (MVO) area, and myocardial salvage index (MSI). Results In CMR analysis, myocardial infarct size was larger in the high D-dimer group than in the low D-dimer group (22.3% [16.2–30.5] versus 18.8% [10.7–26.7]; p = 0.02). Compared to the low D-dimer group, the high D-dimer group also had a larger AAR (38.1% [31.7–46.9] versus 35.8% [24.2–45.3]; p = 0.04) and a smaller MSI (37.7 [28.2–46.9] versus 47.1 [33.2–57.0]; p = 0.01). In multivariate analysis, high D-dimer levels were significantly associated with larger myocardial infarct (OR 2.59; 95% CI 1.37–4.87; p<0.01) and lower MSI (OR 2.62; 95% CI 1.44–4.78; p<0.01). Conclusions In STEMI patients undergoing primary PCI, high D-dimer levels on admission were associated with a larger myocardial infarct size, a greater extent of AAR, and lower MSI, as assessed by CMR data. Elevated initial D-dimer level may be a marker of advanced myocardial injury in patients treated with primary PCI for STEMI. PMID:27513758

  9. 麒麟心痛舒对非ST段抬高型急性冠脉综合征合并消化道出血患者的疗效观察%An observation on therapeutic effect of Qilin Xintongshu pill for treatment of patients with non-ST segment elevation acute coronary syndromes accompanied by gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    李景君; 孙红娟; 陶愈婷; 王国蕾; 黄积存; 李亮; 苏会钦

    2014-01-01

    Objective To observe the therapeutic effect of Qilin Xintongshu pill for treatment of patients with non-ST segment elevation acute coronary syndromes(NSTE-ACS)accompanied by gastrointestinal bleeding (GIB). Methods A prospective randomized controlled trial was conducted. A total of 67 hospitalized patients in Cardiovascular Department of Qionghai City Hospital of Traditional Chinese Medicine were divided into therapy group(35 cases)and control group(32 cases). Both groups were given conventional medical treatment(except anti-coagulative agent). In the therapy group,the patients received Qilin Xintongshu pill(the ingredients consisting of panax pseudo-ginsen,dragon's blood,immature orange fruit,etc.)oral administration,once 5 mg and 3 times a day,while in the control group,the patients accepted clopidogrel orally,once 75 g and once a day,the therapeutic course in both groups being 30 days. The major cardiovascular events(such as death,a newly-happened myocardial infarction(MI),MI secondary,obstinately ischemia)and incidence of massive hemorrhage of gastrointestinal tract were compared between the two groups,and the adverse events were observed. Results After treatment,the incidence of cardiovascular events and massive hemorrhage of gastrointestinal tract in the therapy group were decreased significantly compared to those in the control group 〔incidence of cardiovascular events:8.57%(3/35)vs. 28.13%(9/32), incidence of massive hemorrhage of gastrointestinal tract:2.86%(1/35)vs. 21.88%(7/32),both P<0.05〕. Adverse events were not observed in both groups,and the examinations of blood,urine,liver and renal functions were of no abnormalities before and after treatment. Conclusion Qilin Xintongshu pill can effectively reduce the incidences of cardiovascular events and massive hemorrhage of gastrointestinal tract in patients with NSTE-ACS accompanied by GIB in the therapeutic course of 30 days,therefore this traditional Chinese herbal medicine is an ideal agent for

  10. Effect of stress hyperglycemia on long-term prognosis of patients with ST segment elevation acute myocardial infarction%应激性高血糖对急性ST段抬高型心肌梗死患者远期预后的影响

    Institute of Scientific and Technical Information of China (English)

    李青檀; 王冬梅; 汝磊生; 孙家安; 彭育红

    2013-01-01

    目的:探讨急性ST段抬高型心肌梗死(STEMI)患者发生应激性高血糖的相关危险因素,并评估应激性高血糖对STEMI患者远期预后的影响。方法白求恩国际和平医院2009年8月至2010年4月92例初次发生STEMI的非糖尿病住院患者,根据入院后测定的空腹血糖或随机血糖分A组(应激性高血糖组)41例和B组(血糖正常组)51例。平均随访1.5年。结果应激性高血糖的发生率是44.6%(41/92)。A和B组间经logistic回归分析提示女性(OR=8.952,P=0.013)、心功能Killip分级越高(OR=3.530,P=0.048)、肌酸激酶同工酶(CK-MB)峰值越高(OR=9.408,P<0.001)均是应激性高血糖发生的相关危险因素。Cox回归对A和B组患者1~2年内发生的死亡风险进行分析,提示应激性高血糖是远期死亡(RR 1.532,95%CI 1.004~2.337,P=0.048)的独立预测因子。高甘油三酯血症患者远期死亡风险是正常者1.557倍(P=0.041)。结论女性、Killip分级、CK-MB增高是应激性高血糖发生的相关危险因素。应激性高血糖可能是STEMI患者远期预后不良的独立预测因子和危险因素。高甘油三酯血症可能加重患者的死亡风险。%Objective To evaluate the predictors of stress hyperglycemia in patients with ST segment elevation acute myocardial infarction (STEMI) and the effect of stress hyperglycemia on the long-term prognosis of these patients. Methods A total of 92 patients who had no diabetes but sufferred from STEMI for the first time admitted in our hospital from August 2009 to April 2010 were enrolled in this study. The patients were divided into stress hyperglycemia group (n=41) and normal blood glucose group (n=51) according to the results of fasting blood glucose or random blood glucose after admission. The patients were followed up for 1.5 years on average. Results The prevalence of stress hyperglycemia was 44.6% (41/92). Logistic

  11. Acute Effects of Fine Particulate Air Pollution on ST Segment Height: A Longitudinal Study

    Science.gov (United States)

    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 cours...

  12. Effect of PPCI at different time on the prognosis of patients with ST segment elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Xue-yao FENG

    2016-01-01

    Full Text Available Objective  To analyze the influence of emergency direct percutaneous coronary intervention (PPCI at different times on the prognosis of patients with ST segment elevation myocardial infarction (STEMI. Methods  The clinical data of two hundred twenty-three consecutive STEMI patients who were admitted to 306 Hospital of PLA from July 2011 to May 2014 receiving emergency PPCI within 12 hours of symptom onset were retrospectively studied. The patients were divided into three groups according to the admission time: i.e. communal working hour (8:00am-6:00pm, off-hours (6:00pm-8:00am, and weekends and holidays (Sat to Mon 8:00am-8:00am, official holidays. The time for STEM1 in the 3 groups, and the various factors that may affect the prognosis were statistically analyzed. The impacts of different treatment time of PPCI on the prognosis of STEMI patients were compared. Results  A total of 58(26.01%, 86(38.57%, 79(35.43% patients were included in above 3 groups respectively. Apart from age (mean 61.7, 56.7 and 55.8, P=0.018, incidence of hypertension (55.17%, 53.49% and 31.65%, P=0.005 and hyperlipidemia (27.59%, 40.70% and 51.90%, P=0.017, there was no difference in baseline and procedural characteristics among the 3 groups. On logistic regression analysis, off-hour and weekend admissions were not the predictor of 30-day hospital mortality. Whereas the Killip grading (P=0.006, CKMB peak (P=0.037 and the length of hospital stay (P=0.013 were the independent predictive factors of (30-day out of hospital mortality. Conclusions  In the consecutive series of patients with STEMI who receive emergency PPCI, there is no difference in mortality when patients are admitted at different times. DOI: 10.11855/j.issn.0577-7402.2015.12.14

  13. Effect of percutaneous coronary intervention on prognosis of acute ST-segment elevation myocardial infarction in the elderly%介入治疗对老年人急性ST段抬高性心肌梗死预后的影响

    Institute of Scientific and Technical Information of China (English)

    李春华; 丁振江; 王虹; 赵洁; 郝志敏

    2010-01-01

    目的 探讨介入治疗对老年急性ST段抬高性心肌梗死(STEMI)预后的影响. 方法 回顾性分析1998年6月至2008年6月我院心内科住院的STEMI患者1318例,其中老年人338例(25.6%),连续入选符合标准的老年STEMI 316例为研究对象,依据是否行冠状动脉介入治疗(PCI)分两组:PCI组136例(43.0%)和保守治疗组180例(57.0%).收集研究对象的临床资料,并随访2年评价患者预后. 结果 两组患者年龄、性别、高血压、糖尿病、血脂异常、吸烟饮酒史、家族史等比较差异均无统计学意义(P>0.05).两组患者前壁STEMI、心功能Killip Ⅲ~Ⅳ级、静脉溶栓及恶性室性心律失常例数等比较,差异均无统计学意义(P>0.05).随访患者急性心肌梗死二级预防:多数患者戒烟限酒、控制饮食、减轻体质量、坚持运动等,较规律服用预防心室重塑、抗血小板、抗动脉粥样硬化等药物:血管紧张素转换酶抑制剂或血管紧张素受体拮抗剂、阿司匹林、β受体阻滞剂、他汀类药物,两组间比较差异无统计学意义(均P>0.05).2年随访发生再梗死、心功能Ⅲ~Ⅳ级住院人数和1个月病死率比较,保守治疗组均高于PCI组(分别为17.2%与2.2%,OR=9.224,95%CI=2.756~30.876;31.1%与8.1%,OR=5.132,95%CI=2.568~10.257;8.3%与1.5%,OR=6.091,95%CI=1.369~27.105,均P<0.01).老年STEMI的1年、2年病死率比较,保守治疗组明显高于PCI组(分别为21.1%与2.2%,OR=11.864,95%CI=3.577~39.349;32.2%与4.41%,OR=10.301,95%CI=4.289~24.736,P<0.01). 结论 PCI可减少老年STEMI发生再梗死、心功能Ⅲ~Ⅳ级住院和1个月病死率,尤其是可明显减少1年、2年病死率.因此,早期PCI可明显改善老年STEMI患者预后.%Objective To investigate the effect of percutaneous eoronary intervention (PCI) on the prognosis of acute ST-segment elevation myocardial infarction (ASTEMI) in the elderly.Methods The 1318 ASTEMI patients in our hospital from June

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

    Institute of Scientific and Technical Information of China (English)

    白莹; 梁岩; 谭慧琼; 乔树宾; 张峻; 杨艳敏; 章晏; 朱俊

    2014-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2015-01-01

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

  16. Long-term prognosis in an ST-segment elevation myocardial infarction population treated with routine primary percutaneous coronary intervention: from clinical trial to real-life experience

    DEFF Research Database (Denmark)

    Pedersen, Sune; Galatius, Soren; Mogelvang, Rasmus;

    2009-01-01

    BACKGROUND: We sought to describe the long-term prognosis after routine primary percutaneous coronary intervention (pPCI) in a contemporary consecutive population of patients with presumed ST-segment elevation myocardial infarction, compare it with similar results from the landmark DANAMI-2 trial......). Furthermore, the long-term prognosis was the same regardless of whether the pPCI was performed during off hours or office hours. Thus, pPCI including transportation of patients from noninvasive centers can be applied successfully in a real-life population....

  17. Osteoprotegerin predicts long-term outcome in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Pedersen, Sune Folke; Bjerre, Mette; Mogelvang, Rasmus;

    2012-01-01

    : 1.03-1.59; p = 0.03), repeat myocardial infarction (HR: 1.30; CI: 1.00-1.68; p = 0.05) and admission with heart failure (HR: 1.50; CI: 1.18-1.90; p = 0.001). Conclusion: This study shows that OPG independently predicts long-term outcome in STEMI patients treated with pPCI. Eventually, this knowledge...... patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). Methods: We included 716 consecutive STEMI patients admitted to a single high-volume invasive heart center from September 2006 to December 2008. Endpoints were all...

  18. Significance of Early ST-segment Changes in patients After Emergent percutaneous Coronary Intervention on patients With Acute ST-elevation Myocardial Infarction%急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入术后早期ST段变化的意义

    Institute of Scientific and Technical Information of China (English)

    张景昆; 赵运涛; 吴涛; 王斌; 张宗河

    2015-01-01

    Objective To explore the significance of early ST -segment changes in STEMI patients after emergent percutaneous coronary intervention( PCI) . Methods The study enrolled 48 STEMI patients who underwent emergent PCI in Peking University Aerospace School of Clinical Medicine from April 2011 to April 2013. According to ST -segment resolution within 60 minutes after PCI,the subjects were divided into resolution group( ST - segment resolution≥50%)and non -resolution group(ST-segment resolution0. 05)in LVEF and the number of segments with abnormal wall motion. The echocardiography before discharge showed that the resolution group was higher( P0. 05). The resolution group was lower(P0. 05 ) in the incidence rates of angina. The resolution group was lower than non-resolution group in the total incidence rates of malignant arrhythmia,heart failure,angina following myocardial infarction,major adverse cardiovascular events and composite cardiovascular events(χ2 =32. 643,30. 643, 33. 296,4. 023,30. 468;P = 0. 001 ). Conclusion The STEMI patients with early ST - segment resolution have lower incidence of total cardiovascular events,by which the short-term prognosis of STEMI patients can be well predicted,and the early ST-segment resolution usually occur within 30 minutes after PCI. And the finding may provide reference for further clinical research.%目的:探讨急性ST段抬高型心肌梗死( STEMI)患者行急诊经皮冠状动脉介入( PCI)术后早期ST段变化的临床意义。方法2011年4月—2013年4月选取在北京大学航天临床医学院住院行急诊 PCI术的48例急性STEMI患者。根据PCI术后60 min内ST段回落情况将患者分为回落组( ST段回落≥50%)和非回落组( ST段回落0.05)。出院前心脏超声示:回落组患者LVEF高于非回落组,EDV低于非回落组( P0.05)。回落组患者心律失常事件发生率、心力衰竭事件发生率、主要不良心脏事件( MACE)发生

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

    Directory of Open Access Journals (Sweden)

    José Marconi Almeida de Sousa

    2006-02-01

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

  20. Impact of emergency percutaneous coronary intervention on outcomes of ST-segment elevation myocardial infarction patients complicated by out-of-hospital cardiac arrest

    Institute of Scientific and Technical Information of China (English)

    LIU Hong-wei; PAN Wei; WANG Lan-feng; SUN Yan-ming; LI Zhu-qin; WANG Zhong-hua

    2012-01-01

    Background Cardiac arrest is one of the most serious complications of acute myocardial infarction (AMI),especially in the out-of-hospital patients.There is no general consensus as to whether percutaneous coronary intervention (PCI) is effective in treating ST-segment elevation myocardial infarction (STEMI) patients complicated by out-of-hospital cardiac arrest (OHCA).In our study,we evaluated the efficacy of PCI in treating STEMI patients complicated by OHCA through observing their clinical conditions in hospital; including total mortality,adverse cardiac events,stroke,acute renal failure,and gastrointestinal bleeding events.Methods A total of 1827 STEMI patients were enrolled in this study,where 81 were STEMI with OHCA.Between the patients with and without OHCA,and the OHCA patients with and without PCI,we compared the clinical characteristics during hospitalization,including total mortality and incidences of adverse cardiac events,and stroke.Results Compared to the patients without OHCA,the OHCA patients had significantly lower systolic blood pressure (P <0.05) and a faster heart rate (P<0.05),and a higher percentage of Killip class IV or Glasgow coma scale (GCS) ≤7 onadmission (P <0.001).And the in-hospital mortality was higher in the OHCA patients (55.6% vs.2.4%,P <0.001).Comparing the OHCA patients without PCI to the patients with PCI,there was no obvious difference of heart rate,blood pressure or the percentage of Killip class IV and GCS ≤7 on admission,but the incidences of cardiogenic shock,stroke were significantly lower in the with-PCI group during hospitalization (P <0.001,P <0.05).And the in-hospital mortality of the OHCA patients receiving PCI was significantly lower (36.7% vs.84.3%,P<0.001).Conclusions During hospitalization,the incidence of adverse events and mortality are higher in the STEMI with OHCA patients,comparing with the STEMI without OHCA.Emergency PCI reduces the incidence of adverse events and decreases mortality

  1. Increased rate of stent thrombosis and target lesion revascularization after filter protection in primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: 15-month follow-up of the DEDICATION (Drug Elution and Distal Protection in ST Elevation Myocardial Infarction

    DEFF Research Database (Denmark)

    Kaltoft, Anne; Kelbaek, Henning; Kløvgaard, Lene;

    2010-01-01

    The purpose of this study was to evaluate the long-term effects of distal protection during percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).......The purpose of this study was to evaluate the long-term effects of distal protection during percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI)....

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

    International Nuclear Information System (INIS)

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

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

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

    V. A. Sulimov

    2015-09-01

    Full Text Available Ambiguous data about comparability regarding clinical outcomes for prehospital thrombolysis, coupled with timely coronary angiography, and primary percutaneous coronary intervention (PCI in the early after acute ST-segment elevation myocardial infarction (STEMI, there are now.In the STREAM trial 1892 patients with STEMI diagnosed within 3 hours after onset of symptoms, and whom it was impossible to perform primary PCI within 1 h after the first medical contact, were randomly assigned into two treatment groups: a primary PCI b prehospital thrombolytic therapy with bolus tenecteplase (dose decreased by half in patients aged ≥75 years in combination with clopidogrel and enoxaparin followed by admission to the hospital, where it was possible to perform PCI. Emergency coronary angiography performed if thrombolysis failed. Coronary angiography and PCI of the infarct-related artery were performed in the period from 6 to 24 hours after randomization and thrombolytic therapy in the case of an effective thrombolysis. Primary endpoints include a composite of death, shock, congestive heart failure, or reinfarction up to 30 days.The primary endpoint occurred in 116 of 939 patients (12.4 % of the thrombolysis group and in 135 of 943 patients (14.3% of the primary PCI group (relative risk in the group thrombolysis 0.86, 95% confidence interval 0.68-1.09, p=0.21. Emergency angiography was required in 36.3% of patients in the thrombolysis, and the remaining patients, coronary angiography and PCI were performed at a mean of 17 hours after randomization and thrombolytic therapy. Thrombolysis group had more intracranial hemorrhages than primary PCI group (1.0% vs 0.2%, p=0.04; after correction protocol and dose reduction by half of tenecteplase in patients ≥75 years: 0.5% vs. 0.3%, p=0.45. The rate of non- intracranial bleeding in two treatment groups did not differ.Prehospital thrombolysis followed by coronary angiography and timely PCI provide effective

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

    Directory of Open Access Journals (Sweden)

    V. A. Sulimov

    2013-01-01

    Full Text Available Ambiguous data about comparability regarding clinical outcomes for prehospital thrombolysis, coupled with timely coronary angiography, and primary percutaneous coronary intervention (PCI in the early after acute ST-segment elevation myocardial infarction (STEMI, there are now.In the STREAM trial 1892 patients with STEMI diagnosed within 3 hours after onset of symptoms, and whom it was impossible to perform primary PCI within 1 h after the first medical contact, were randomly assigned into two treatment groups: a primary PCI b prehospital thrombolytic therapy with bolus tenecteplase (dose decreased by half in patients aged ≥75 years in combination with clopidogrel and enoxaparin followed by admission to the hospital, where it was possible to perform PCI. Emergency coronary angiography performed if thrombolysis failed. Coronary angiography and PCI of the infarct-related artery were performed in the period from 6 to 24 hours after randomization and thrombolytic therapy in the case of an effective thrombolysis. Primary endpoints include a composite of death, shock, congestive heart failure, or reinfarction up to 30 days.The primary endpoint occurred in 116 of 939 patients (12.4 % of the thrombolysis group and in 135 of 943 patients (14.3% of the primary PCI group (relative risk in the group thrombolysis 0.86, 95% confidence interval 0.68-1.09, p=0.21. Emergency angiography was required in 36.3% of patients in the thrombolysis, and the remaining patients, coronary angiography and PCI were performed at a mean of 17 hours after randomization and thrombolytic therapy. Thrombolysis group had more intracranial hemorrhages than primary PCI group (1.0% vs 0.2%, p=0.04; after correction protocol and dose reduction by half of tenecteplase in patients ≥75 years: 0.5% vs. 0.3%, p=0.45. The rate of non- intracranial bleeding in two treatment groups did not differ.Prehospital thrombolysis followed by coronary angiography and timely PCI provide effective

  6. Usefulness of local delivery of thrombolytics before thrombectomy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (the delivery of thrombolytics before thrombectomy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention [DISSOLUTION] randomized trial).

    Science.gov (United States)

    Greco, Cesare; Pelliccia, Francesco; Tanzilli, Gaetano; Tinti, Maria Denitza; Salenzi, Paola; Cicerchia, Cristina; Schiariti, Michele; Franzoni, Ferdinando; Speziale, Giuseppe; Gallo, Pietro; Gaudio, Carlo

    2013-09-01

    Thrombus aspiration during percutaneous coronary intervention can result in improved rates of normal epicardial flow and myocardial perfusion, but several unmet needs remain. The purpose of the Delivery of thrombolytIcs before thrombectomy in patientS with ST-segment elevatiOn myocardiaL infarction Undergoing primary percuTaneous coronary interventION (DISSOLUTION) trial was to evaluate the hypothesis that local delivery of thrombolytics can enhance the efficacy of thrombus aspiration in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. A total of 102 patients with ST-segment elevation myocardial infarction and angiographic evidence of massive thrombosis in the culprit artery were randomly assigned to receive a local, intrathrombus bolus of 200,000 U of urokinase (n = 51) or saline solution (n = 51) by way of an infusion microcatheter, followed by manual aspiration thrombectomy. The end points included the final Thrombolysis In Myocardial Infarction flow grade and frame count, myocardial blush grade, 60-minute ST-segment resolution >70%, and major adverse cardiac and cerebrovascular events, defined as the death, reinfarction, stroke, or clinically driven target vessel revascularization at 6 months. The use of intrathrombus urokinase was associated with a significantly higher incidence of Thrombolysis In Myocardial Infarction flow grade 3 (90% vs 66%, p = 0.008) and lower postpercutaneous coronary intervention Thrombolysis In Myocardial Infarction frame count (19 ± 15 vs 25 ± 17, p = 0.033). The postprocedural myocardial perfusion was significantly increased with the use of urokinase (myocardial blush grade 2 or 3, 68% vs 45%, p = 0.028), with more patients showing ST-segment resolution >70% (82% vs 55%, p = 0.006). At 6 months of follow-up, the patients treated with intrathrombus urokinase showed a better major adverse cardiac event-free survival (6% vs 21%; log-rank p = 0.044). In conclusion, local

  7. Everolimus-eluting bioresorbable stent vs. durable polymer everolimus-eluting metallic stent in patients with ST-segment elevation myocardial infarction

    DEFF Research Database (Denmark)

    Sabaté, Manel; Windecker, Stephan; Iñiguez, Andres;

    2015-01-01

    AIMS: Patients with ST-segment elevation myocardial infarction (STEMI) feature thrombus-rich lesions with large necrotic core, which are usually associated with delayed arterial healing and impaired stent-related outcomes. The use of bioresorbable vascular scaffolds (Absorb) has the potential...... to overcome these limitations owing to restoration of native vessel lumen and physiology at long term. The purpose of this randomized trial was to compare the arterial healing response at short term, as a surrogate for safety and efficacy, between the Absorb and the metallic everolimus-eluting stent (EES...... was the 6-month optical frequency domain imaging healing score (HS) based on the presence of uncovered and/or malapposed stent struts and intraluminal filling defects. Main secondary endpoint included the device-oriented composite endpoint (DOCE) according to the Academic Research Consortium definition...

  8. Prevalence and prognostic implications of non-sustained ventricular tachycardia in ST-segment elevation myocardial infarction after revascularization with either fibrinolysis or primary angioplasty

    DEFF Research Database (Denmark)

    Høfsten, Dan Eik; Wachtell, Kristian; Lund, Birgit;

    2007-01-01

    AIMS: We compared the prevalence and prognostic implications of non-sustained ventricular tachycardia (nsVT) detected early after ST-segment elevation myocardial infarction (STEMI) in patients randomized to either fibrinolysis or primary angioplasty in the DANAMI-2 trial. METHODS AND RESULTS......: Holter recordings were available in 1017 patients (fibrinolysis: n=501; primary angioplasty: n=516). Primary endpoint was all-cause mortality. The prevalence of nsVT was 8.8% in fibrinolysis-treated, and 8.1% in primary angioplasty-treated patients (P=0.71). During 4519 patient-years of follow-up (median...... 4.3 years), 116 patients died [fibrinolysis vs. angioplasty: HR=1.1 (95% CI, 0.8-1.6), P=0.47]. In univariate analysis, nsVT patients treated with fibrinolysis, had significantly higher mortality when compared with those without nsVT (P

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

    Institute of Scientific and Technical Information of China (English)

    王树碧

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    José Roberto Matos Souza

    2008-02-01

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

  11. Polyvascular Disease and Long-term Cardiovascular Outcomes in Older Patients with Non–ST-segment Elevation Myocardial Infarction

    Science.gov (United States)

    Subherwal, Sumeet; Bhatt, Deepak L.; Li, Shuang; Tracy Y., Wang; Thomas, Laine; Alexander, Karen P.; Patel, Manesh R.; Ohman, E. Magnus; Gibler, W. Brian; Peterson, Eric D.; Roe, Matthew T.

    2013-01-01

    Background The impact of polyvascular disease (peripheral arterial disease [PAD] and/or cerebrovascular disease [CVD]) on long-term cardiovascular outcomes among older patients with acute myocardial infarction (MI) has not been well studied. Methods Non–ST-elevation MI (NSTEMI) patients aged ≥65 years from the CRUSADE registry who survived to hospital discharge were linked to longitudinal data from the Centers for Medicare and Medicaid Services (n=34,205). All patients were presumed to have coronary artery disease (CAD) and were classified into 4 groups: 10.7% had prior CVD (CAD+CVD group); 11.5% had prior PAD (CAD+PAD); 3.1% had prior PAD and CVD (CAD+PAD+CVD); and 74.7% had no polyvascular disease (CAD alone). Cox proportional hazard modeling was used to examine the hazard of long-term mortality and the composite of death, readmission for MI, or readmission for stroke (median follow-up 35 months, IQR 17–49) among the 4 groups. Results Compared with the CAD-alone group, patients with polyvascular disease had a greater comorbidity burden, were less likely to undergo revascularization, and less often received recommended discharge interventions. Three-year mortality rates increased with a greater number of arterial beds involved: 33% for CAD alone, 49% for CAD+PAD, 52% for CAD+CVD, and 59% for CAD+PAD+CVD. Relative to the CAD-alone group, patients with all 3 arterial beds involved had the highest risk of long-term mortality (adjusted HR [95% CI]: 1.49 [1.38–1.61], with a lower risk for those with CAD+CVD, 1.38 [1.31–1.44], and those with CAD+PAD, 1.29 [1.23–1.35]). Similarly, the adjusted risk of long-term composite ischemic events was highest among the CAD+PAD+CVD group. Conclusions Older NSTEMI patients with polyvascular disease have substantially higher long-term risk, such that the 3-year mortality rate is >50%. Future studies targeting greater adherance to secondary prevention strategies and novel therapies are needed to help reduce long

  12. Culprit Vessel Only Versus Multivessel and Staged Percutaneous Coronary Intervention for Multivessel Disease in Patients Presenting With ST-Segment Elevation Myocardial Infarction A Pairwise and Network Meta-Analysis

    NARCIS (Netherlands)

    Vlaar, Pieter J.; Mahmoud, Karim D.; Holmes, David R.; van Valkenhoef, Gert; Hillege, Hans L.; van der Horst, Iwan C. C.; Zijlstra, Felix; de Smet, Bart J. G. L.

    2011-01-01

    Objectives The purposes of this study were to investigate whether, in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD), percutaneous coronary intervention (PCI) should be confined to the culprit or also nonculprit vessels and, when performing PCI for non

  13. CYP2C19 genotype-guided antiplatelet therapy in ST-segment elevation myocardial infarction patients-Rationale and design of the Patient Outcome after primary PCI (POPular) Genetics study

    NARCIS (Netherlands)

    Bergmeijer, Thomas O.; Janssen, Paul W.A.; Schipper, Jurjan C.; Qaderdan, Khalid; Ishak, Maycel; Ruitenbeek, Rianne S.; Asselbergs, Folkert W.; van 't Hof, Arnoud W.J.; Dewilde, Willem J.M.; Spanó, Fabrizio; Herrman, Jean-Paul R.; Kelder, Johannes C.; Postma, Maarten J.; de Boer, Anthonius; Deneer, Vera H.M.; ten Berg, Jurriën M.

    2014-01-01

    RATIONALE: In patients with ST-segment elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (pPCI), the use of dual antiplatelet therapy is essential to prevent atherothrombotic complications. Therefore, patients are treated with acetylsalicylic acid and clo

  14. Health Care System Delay and Heart Failure in Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Follow-up of Population-Based Medical Registry Data

    DEFF Research Database (Denmark)

    Terkelsen, Christian Juhl; Jensen, Lisette Okkels; Hansen, Hans-Henrik Tilsted;

    2011-01-01

    In patients with ST-segment elevation myocardial infarction (STEMI), delay between contact with the health care system and initiation of reperfusion therapy (system delay) is associated with mortality, but data on the associated risk for congestive heart failure (CHF) among survivors are limited....

  15. Prasugrel versus clopidogrel for patients with unstable angina or non-ST-segment elevation myocardial infarction with or without angiography

    DEFF Research Database (Denmark)

    Wiviott, Stephen D; White, Harvey D; Ohman, E Magnus;

    2013-01-01

    Treatment with prasugrel and aspirin improves outcomes compared with clopidogrel and aspirin for patients with acute coronary syndrome who have had angiography and percutaneous coronary intervention; however, no clear benefit has been shown for patients managed first with drugs only. We assessed ...

  16. rPA联合还原型谷胱甘肽治疗急性ST段抬高型心肌梗死的疗效%Effects of rPA combined with reduced glutathione hormone on acute ST segment elevation myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    李永东; 董春花

    2012-01-01

    Objective: To observe therapeutic effects and safety of recombinant human tissue type plasminogen activator (rPA) combined with reduced glutathione hormone (GSH) on patients with acute ST elevation myocardial infarction (STEMI). Methods: A total of 80 acute STEMI cases were randomly and equally divided into routine thrombolysis group and GSH group (received GSH based on routine thrombolysis). Plasma levels of cTnT, CK-MB and activity of superoxide dismutase (SOD) were measured before and 24h after treatment. On one month after treatment, LVEDd, LVESd and LVEF were measured; incidence rates of adverse cardiovascular events (MACE) were detected. Results: (1) Compared with before treatment, plasma levels of CK-MB, cTnT and SOD significantly increased after treatment in both groups (P<0. 01 all), but compared with routine thrombolysis group the levels of CK-MB, cTnT were less, and SOD was more in GSH group (P<0. 05 all); (2) Compared with routine thrombolysis group, there were significantly decreased in LVEDd [ (55. 01 ± 3. 56) mm vs. (51. 58 ± 2. 97) mm], LVESd [ (47. 34 ± 4. 83) mm vs. (42. 95 ± 4. 58) mm] , and significantly increased in LVEF [ (54. 76 + 4. 73) % vs. (61. 21 ± 6. 38)%] in GSH group, P<0. 05 all; 3. Compared with routine thrombolysis group, there were significantly decreased in incidence rate of angina pectoris after myocardial infarction (35. 0% vs. 22. 5%), recurrence rate of myocardial infarction (22. 5% vs. 5. 0%) and incidence rate of severe arrhythmias (37. 5% vs. 17. 5%) in GSH group, P<0. 05 all. Conclusion: rPA combined with GSH can significantly decrease MACE after coronary artery recanalization in patients with acute STEMI. GSH can exert protective effects on impaired myocardium after ischemia- reperf usion.%目的:观察重组人组织型纤溶酶原激活剂(rPA)联合还原型谷胱甘肽(GSH)治疗急性ST段抬高型心肌梗死(STEMI)的疗效及安全性.方法:80例急性STEMI患者被随机均分为常规

  17. Effect of high loading dose of clopidogrel plus tirofiban on percutaneous coronary intervention in patients with non-ST-segment elevation acute coronary syndrome%高负荷氯吡格雷联合替罗非班在非ST段抬高型急性冠状动脉综合征经皮冠状动脉介入治疗中的作用

    Institute of Scientific and Technical Information of China (English)

    齐丽平

    2012-01-01

    目的 探讨高负荷剂量氯吡格雷联合替罗非班在高危非ST段抬高型急性冠状动脉综合征(acute coronary syndrome,ACS)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)中的作用及安全性.方法 152例拟行PCI术的高危非ST段抬高型ACS患者,术前口服氯吡格雷600 mg+替罗非班0.4 μg/(kg·min)静脉注射30 min,继以0.1μg/(kg·min)持续静脉泵入至术后36h者72例为观察组,术前仅口服氯吡格雷600 mg者80例为对照组,观察PCI术后TIMI血流分级、心肌灌注、30 d内主要不良心血管事件和出血并发症发生率.结果 PCI术后观察组患者心肌灌注分级TMPG 2级以上发生率(87.5%)高于对照组(72.5%)(P<0.05),观察组校正TIMI计帧数(24.70±6.60)小于对照组(27.33±6.42)(P<0.05);2组PCI术后病变血管血流TIMI 3级发生率比较差异无统计学意义(P>0.05);观察组30 d主要不良心血管事件发生率(9.7%)低于对照组(23.8%)(P<0.05),2组出血事件发生率比较差异无统计学意义(P>0.05).结论 PCI术前静脉应用替罗非班联合高负荷剂量氯吡格雷,可改善ACS患者PCI术后心肌灌注、减少30 d内主要心血管事件发生率,且不增加出血风险.%Objective To evaluate the effect and safety of high loading dose of clopidogrel plus tirofiban on percutaneous coronary intervention (PCI) m patients with high-risk non-S I -segment elevation acute coronary syndrome (ACS). Methods A total of 152 patients with high-risk non-ST-segment elevation ACS who needed percutaneous coronary intervention were divided into experimental group (n = 72) and control group (n = 80). The experimental group received oral administration of clopidogrel 600 rag plus tirofiban intravenous injection of 0. 4 μg/(kg · min) for 30 minutes before operation, and followed by continuous tirofiban intravenous injection of 0. 1 μg/(kg · mini by 36 hours after opration. The control group received oral administration

  18. Systematic review: comparative effectiveness of adjunctive devices in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention of native vessels

    Directory of Open Access Journals (Sweden)

    Sobieraj Diana M

    2011-12-01

    Full Text Available Abstract Background During percutaneous coronary intervention (PCI, dislodgement of atherothrombotic material from coronary lesions can result in distal embolization, and may lead to increased major adverse cardiovascular events (MACE and mortality. We sought to systematically review the comparative effectiveness of adjunctive devices to remove thrombi or protect against distal embolization in patients with ST-segment elevation myocardial infarction (STEMI undergoing PCI of native vessels. Methods We conducted a systematic literature search of Medline, the Cochrane Database, and Web of Science (January 1996-March 2011, http://www.clinicaltrials.gov, abstracts from major cardiology meetings, TCTMD, and CardioSource Plus. Two investigators independently screened citations and extracted data from randomized controlled trials (RCTs that compared the use of adjunctive devices plus PCI to PCI alone, evaluated patients with STEMI, enrolled a population with 95% of target lesion(s in native vessels, and reported data on at least one pre-specified outcome. Quality was graded as good, fair or poor and the strength of evidence was rated as high, moderate, low or insufficient. Disagreement was resolved through consensus. Results 37 trials met inclusion criteria. At the maximal duration of follow-up, catheter aspiration devices plus PCI significantly decreased the risk of MACE by 27% compared to PCI alone. Catheter aspiration devices also significantly increased the achievement of ST-segment resolution by 49%, myocardial blush grade of 3 (MBG-3 by 39%, and thrombolysis in myocardial infarction (TIMI 3 flow by 8%, while reducing the risk of distal embolization by 44%, no reflow by 48% and coronary dissection by 70% versus standard PCI alone. In a majority of trials, the use of catheter aspiration devices increased procedural time upon qualitative assessment. Distal filter embolic protection devices significantly increased the risk of target revascularization

  19. Efficacy comparison between direct stent implantation surgery and deferred stent implantation surgery for patients with ST-segment elevation myocardial infarction after PCT thrombus aspiration surgery

    Institute of Scientific and Technical Information of China (English)

    Xiao-Xia Han; Xiu-Hong Liu; Ping Zhou; Guo-Mei Dan

    2016-01-01

    Objective:To compare the efficacy of direct stent implantation surgery and deferred stent implantation surgery for patients with ST-segment elevation myocardial infarction after PCT thrombus aspiration surgery. Method:A total of 74 cases with STEMI were selected, who had been given PCT thrombus aspiration surgery treatment, and were randomly divided into direct group and deferred group (n=37). Patients in direct group were given direct stent implantation surgery after PCT thrombus aspiration surgery treatment. Patients in deferred group were given deferred stent implantation surgery 14 d later after anticoagulant and anti-platelet treatment. Heart structure and function, stent release characteristics and adverse reactions) were compared 6 months after the surgery. Results:Two hours after surgery, ST segment drop amplitude in deferred group was significantly higher than that in direct group (P<0.05);TIMI frame number was obvious and no reflow/slow blood flow occurrence ratio was significantly lower than that in direct group (P<0.05);implantation stent number and stent length in deferred group were significantly less than that in direct group (P<0.05);the release characteristic indexes of implantation stent in deferred group:stent diameter and stent expansion pressure were significantly higher than that in direct group (P<0.05);6 months after surgery, LVEF improvement in deferred group was significantly higher than that in direct group (P<0.05), while LVEDD、LVEDV ventricular remodeling was significantly lower than that in direct group (P<0.05);The total adverse event occurrence rate in deferred group was 5.4%, which was significantly lower than that in direct group (18.9%) (P<0.05). Conclusions:The deferred stent implantation surgery after PCI thrombus aspiration surgery could obviously reduce the occurrence rate of no reflow/slow blood flow, obviously improve the heart function and myocardial perfusion, reduce the usage amount of stent, reduce the occurrence of

  20. Sensitivity and specificity of strain imaging in evaluating myocardial viability among patients with ST-segment elevation acute myocardial infarction%应变显像评价ST段抬高急性心肌梗死患者存活心肌的敏感性与特异性

    Institute of Scientific and Technical Information of China (English)

    阮雯; 舒先红; 石洪成; 潘翠珍; 周易; 陈灏珠

    2008-01-01

    目的 比较应变显像(SI)与静息-再分布201Tl心肌灌注显像(RR-201Tl-SPECT)预测ST段抬高的急性心肌梗死(AMI)患者存活心肌的敏感性与特异性.方法 对26例AMI患者进行介入治疗1周后行超声心动图和RR-201Tl-SPECT检查,并随访治疗≥3个月后的超声心动图.测量左室长轴16节段的应变及RR-201 Tl-SPECT心肌灌注评分,以1周和≥3个月的室壁运动评分(WMS)对比作为判定存活心肌的"金标准".结果 ①共研究260个缺血节段.随访(5±2)月,据WMS判定存活节段201个,梗死节段59个.RR-201 Tl-SPECT预测存活心肌的敏感性和特异性为87%(175/201)和58%(34/59).②以收缩期应变(Set)<-6%为最佳截止点预测存活心肌的敏感性和特异性分别为81%(161/201)和66%(39/59).③Set与RR-201 Tl-SPECT总符合率77%(199/260),具有中等一致性(Kappa=0.40).结论 S1评价ST段抬高AMI患者的存活心肌是可行的,其与RR-201 Tl-SPECT显像诊断效力相似,是更简便、无创、低成本的替代选择.%Obiective To compare the sensitivity and specificity of strain imaging(SI)and restredistribution Tl-201(RR-201 TI)SPECT imaging in evaluating myocardial viability among patients with STelevation acute myocardial infarction(AMI).Methods Twenty-six AMI patients underwent echocardiography and RR-201 Tl-SPECT imaging a week(baseline)after percutaneous coronary intervention(PCI)therapy.At baseline,wall motion score(WMS)and systolic strain were assessed,SPECT scoring were performed on 16 segments of left ventricle(LV).WMS was repeated more than 3 months later to assess myocardial viability,which is deemed as reference.Results ①Two hundred and sixty segments in the"at risk"regions were followed up for(5±2)months,among which 201 were identified as viable and 59 were not,according to the WMS.②In comparison to the reference standard,the sensitivity and specificity of RR-201 Tl-SPECT to predict myocardial viability were 87%(175/201)and 58%(34/59)respectively

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

    DEFF Research Database (Denmark)

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

    1998-01-01

    Based on serial Holter monitoring performed 7 times within 3 years after a first acute myocardial infarction, we assessed the prevalence, variability and long-term clinical importance of transient myocardial ischemia (TMI) defined as episodes of ambulatory ST-segment depression. In all, 121...... consecutive male patients Holter recordings varied around 20% ranging between 18 and 27%. Fifty-five of the patients (46%) had TMI on at least 1 of the 7 Holter recordings. Considerable variability was found within and between patients...... for the presence of TMI. No high-risk group for cardiac death, nonfatal reinfarction or coronary revascularization during up to 10 years of follow-up could be identified by the detection of TMI. From these results we conclude that a routine search for TMI on serial Holter monitoring cannot be recommended in male...

  2. Enhancing the efficacy of delivering reperfusion therapy: a European and North American experience with ST-segment elevation myocardial infarction networks.

    Science.gov (United States)

    Huber, Kurt; Goldstein, Patrick; Danchin, Nicolas; Fox, Keith A A; Welsh, Robert; Granger, Christopher B; Henry, Timothy; Gersh, Bernard J

    2013-02-01

    Advances in technique and adjunctive medication have improved outcome of ST-segment elevation myocardial infarction (STEMI) patients. However, the timely delivery and administration of reperfusion strategies to all eligible patients remain challenging. Currently, up to one-third of eligible STEMI patients in industrialized countries worldwide receive no specific reperfusion treatment, a problem that is rectified by the development and implementation of STEMI networks, as also recommended by the latest European Society of Cardiology and American College of Cardiology/American Heart Association guidelines. Indeed, over the last 5 years, published figures demonstrate that STEMI networks increase the percentage of patients treated by any reperfusion strategy, and the percentage of patients receiving treatment within the recommended time frames has also improved, thereby reducing in-hospital and long-term mortality to very low levels. This manuscript demonstrates how STEMI networks can be adapted to local needs and circumstances against pre-existing barriers and despite the heterogeneity in local situations, patient's characteristics, treatment delays, and distances for transfer. Modern and efficacious networks must be prepared to offer both primary percutaneous coronary intervention and thrombolytic therapy, preferably prehospital, as long as primary percutaneous coronary intervention cannot be guaranteed to all individuals within the recommended timeline.

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

    Science.gov (United States)

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

    2016-06-01

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

  4. Ranolazine Therapy Reduces Non-ST-Segment-Elevation Myocardial Infarction and Unstable Angina in Coronary Disease Patients with Angina.

    Science.gov (United States)

    Murray, Gary L; Colombo, Joseph

    2016-09-01

    High sympathetic tone and cardiac autonomic neuropathy (CAN) are associated with major adverse cardiac events (MACE). We have shown ranolazine (RAN) improves autonomic function. RAN was introduced to 51 successive anginal CD patients (RANCD). A control group of 54 successive nonanginal CD patients (NORANCD) continued baseline therapy. Mean study duration was 6.1 years, which included semi-annual autonomic function measures (ANX 3.0, ANSAR Medical Technologies, Inc., Philadelphia, PA) and yearly myocardial perfusion SPECT studies (MPI). MACE were experienced by 29% RANCD patients versus 46% NORANCD patients (p = 0.0105). The patients from both groups with abnormal parasympathetic and sympathetic (P&S) measures and MACE totaled 52 of those patients with MACE versus 17% of those patients without MACE (p = 0.0274). Abnormal MPI was demonstrated in 35% of those with abnormal (P&S) measures and MACE versus 12% without MACE. Sympathovagal balance (SB) was lower, indicating higher, relative parasympathetic tone (known to be cardioprotective) in the RANCD group. Acute coronary syndromes occurred 4.5 times as often in NORANCD patients. High SB occur more frequently than abnormal MPI in CD patients experiencing MACE. In addition to increased myocardial blood flow as its proposed mechanism of angina relief, RAN improves P&S measures, a potentially new mechanism whereby RAN improves outcomes.

  5. Three hours continuous injection of adenosine improved left ventricular function and infarct size in patients with ST-segment elevation myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    ZHANG Hang; TIAN Nai-liang; HU Zuo-ying; WANG Feng; CHEN Liang; ZHANG Yao-jun; CHEN Shao-liang

    2012-01-01

    Background The definitive treatment for myocardial ischemia is reperfusion.However,reperfusion injury has the potential to cause additional reversible and irreversible damage to the myocardium.One likely candidate for a cardioprotection is adenosine.The present study aimed at investigating the effect of intravenous adenosine on clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).Methods Patients with STEMI within 12 hours from the onset of symptoms were randomized by 1:1:1 ratio to receive either adenosine 50 μg·kg-1·min-1 (low-dose group,n=31),or 70 μgkg-1·min-1 (high-dose group,n=32),or saline 1 ml/min (control group,n=27) for three hours.Drugs were given to the patients immediately after the guide wire crossed the culprit lesion.Recurrence of no-reflow,TIMI flow grade (TFG) and TIMI myocardial perfusion grade (TMPG),and collateral circulation were recorded.The postoperative and preoperative ST segment elevation sum of 18-lead electrocardiogram (ECG) and their ratio (STsum-post/STsum-pre) were recorded,as well as the peak time and peak value of CK-MB enzyme.Serial cardiac echo and myocardial perfusion imaging were performed at 24 hours and 6 months post-stenting.The primary endpoint was left ventricular function,and infarct size.The secondary end-point was the occurrence of cardiac and non-cardiac death,non-fatal myocardial infarction,and heart failure.Results A total of 90 STEMI patients were studied.No-reflow immediately after stent procedure was seen in 11 (35.5%)patients in the control group,significantly different from 6.3% in the low-dose group or 3.7% in the high-dose group (both P=0.001).STsum-post/STsum-pre in the low-dose and high-dose groups was significantly different from the control group (low-dose group vs.control group,P=0.003 and high-dose group vs.control group,P=0.001),without a dose-dependent pattern (P=0.238).The peak value of CK-MB enzyme

  6. Culprit vessel only versus“one-week”staged percutaneous coronary intervention for multivessel disease in patients presenting with ST-segment elevation myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    Li-Xiang MA; Zhen-Hua LU; Le WANG; Xin DU; Chang-Sheng MA

    2015-01-01

    Objective To explore the impact of a“one-week”staged multivessel percutaneous coronary intervention (PCI) versus culprit-only PCI on deaths and major adverse cardiac events (MACE). Methods We retrospectively analyzed 447 patients with multivessel disease who experienced a ST-segment elevation myocardial infarction (STEMI) within 12 h before undergoing PCI between July 26, 2008 and Septem-ber 25, 2011. After completion of PCI in the infarct artery, 201 patients still in the hospital agreed to undergo PCI in non-infarct arteries with more than 70%stenosis for a“one-week”staged multivessel PCI. A total of 246 patients only received intervention for the culprit vessel. Follow-up ended on September 9, 2014. This study examined the differences in deaths from any cause (i.e., cardiac and noncardiac) and MACE between the two treatment groups. Results Compared to a culprit-only PCI treatment approach, the“one-week”staged multivessel PCI was strongly associated with greater benefits for 55-month all cause death [41 (16.7%) vs.13 (6.5%), P=0.004] and MACE [82 (33.3%) vs. 40 (19.9%), P=0.002] rates. In addition, there were significant differences in the number of myocardial infarctions [43 (17.5%) vs. 20 (10.0%), P=0.023], coronary-artery bypass grafting [CABG;20 (8.1%) vs. 6 (3.0%), P=0.021], and PCI [31 (12.6%) vs. 12 (6.0%), P=0.018]. Patients undergoing culprit-only PCI compared to“one-week”PCI had the same number of stent thrombosis events [7 (2.8%) vs. 3 (1.5%), P=0.522]. Conclusions Compared to a culprit-only PCI treatment approach,“one-week”staged multi-vessel PCI was a safe and effective selection for STEMI and multi-vessel PCI.

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

    Science.gov (United States)

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

    2015-02-01

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

  8. System dynamics modeling in the evaluation of delays of care in ST-segment elevation myocardial infarction patients within a tiered health system.

    Directory of Open Access Journals (Sweden)

    Luciano de Andrade

    Full Text Available Mortality rates amongst ST segment elevation myocardial infarction (STEMI patients remain high, especially in developing countries. The aim of this study was to evaluate the factors related with delays in the treatment of STEMI patients to support a strategic plan toward structural and personnel modifications in a primary hospital aligning its process with international guidelines.The study was conducted in a primary hospital localized in Foz do Iguaçu, Brazil. We utilized a qualitative and quantitative integrated analysis including on-site observations, interviews, medical records analysis, Qualitative Comparative Analysis (QCA and System Dynamics Modeling (SD. Main cause of delays were categorized into three themes: a professional, b equipment and c transportation logistics. QCA analysis confirmed four main stages of delay to STEMI patient's care in relation to the 'Door-in-Door-out' time at the primary hospital. These stages and their average delays in minutes were: a First Medical Contact (From Door-In to the first contact with the nurse and/or physician: 7 minutes; b Electrocardiogram acquisition and review by a physician: 28 minutes; c ECG transmission and Percutaneous Coronary Intervention Center team feedback time: 76 minutes; and d Patient's Transfer Waiting Time: 78 minutes. SD baseline model confirmed the system's behavior with all occurring delays and the need of improvements. Moreover, after model validation and sensitivity analysis, results suggested that an overall improvement of 40% to 50% in each of these identified stages would reduce the delay.This evaluation suggests that investment in health personnel training, diminution of bureaucracy, and management of guidelines might lead to important improvements decreasing the delay of STEMI patients' care. In addition, this work provides evidence that SD modeling may highlight areas where health system managers can implement and evaluate the necessary changes in order to improve the

  9. Comparison of clinical outcomes between culprit vessel only and multivessel percutaneous coronary intervention for ST-segment elevation myocardial infarction patients with multivessel coronary diseases

    Institute of Scientific and Technical Information of China (English)

    Kwang Sun Ryu; Sang Yeub Lee; Jang Whan Bae; Kyung Kuk Hwang; Dong Woon Kim; Myeong Chan Cho; Young Keun Ahn; Myung Ho Jeong; Chong Jin Kim; Jong Seon Park; Young Jo Kim; Hyun Woo Park; Yang Soo Jang; Hyo Soo Kim; Ki Bae Seung; Soo Ho Park; Ho Sun Shon; Keun Ho Ryu; Dong Gyu Lee; Mohamed EA Bashir; Ju Hee Lee; Sang Min Kim

    2015-01-01

    Background The clinical significance of complete revascularization for ST segment elevation myocardial infarction (STEMI) pa-tients during admission is still debatable. Methods A total of 1406 STEMI patients from the Korean Myocardial Infarction Registry with multivessel diseases without cardiogenic shock who underwent primary percutaneous coronary intervention (PPCI) were analyzed. We used propensity score matching (PSM) to control differences of baseline characteristics between culprit only intervention (CP) and multivessel percutaneous coronary interventions (MP), and between double vessel disease (DVD) and triple vessel disease (TVD). The major adverse cardiac event (MACE) was analyzed for one year after discharge. Results TVD patients showed higher incidence of MACE (14.2%vs. 8.6%, P=0.01), any cause of revascularization (10.6%vs. 5.9%, P=0.01), and repeated PCI (9.5%vs. 5.7%, P=0.02), as compared to DVD patients during one year after discharge. MP reduced MACE effectively (7.3%vs. 13.8%, P=0.03), as compared to CP for one year, but all cause of death (1.6%vs. 3.2%, P=0.38), MI (0.4%vs. 0.8%, P=1.00), and any cause of revascularization (5.3%vs. 9.7%, P=0.09) were comparable in the two treatment groups. Conclusions STEMI patients with TVD showed higher rate of MACE, as compared to DVD. MP performed during PPCI or ad hoc during admission for STEMI patients without cardiogenic shock showed lower rate of MACE in this large scaled database. Therefore, MP could be considered as an effective treatment option for STEMI patients without cardiogenic shock.

  10. Clinical outcomes of serolimus-eluting stents versus bare metal stents in ST-segment elevation myocardial infarction patients: a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    PAN Xiao-hong; ZHONG Wen-zhao; XIANG Mei-xiang; XU Geng; SHAN Jiang; WANG Jia-nan

    2009-01-01

    Background The benefits and safety of sirolimus-eluting stent (SES) have not been systematically quantified in different trials in ST-segment elevation myocardial infarction (STEMI) patients with primary or rescue percutaneous coronary intervention (PCI). A meta-analysis of randomised trials comparing SES and bare-metal stent (BMS) was performed. Methods A systematic literature search was conducted to identify all randomized clinical trials. The primary outcome was the rate of major adverse cardiac events (MACEs). The secondary outcomes included death, recurrent myocardial infarction, recurrent revascularization, and stent thrombosis. Results Totally, 1973 STEMI patients were enrolled in seven eligible randomized trials comparing SES with BMS. The pooled rate of major adverse cardiac events was significantly lower in the SES group than in the BMS group (9.7% vs 20.3%, OR 2.45, 95% Cl 1.88-3.19, P < 0.00001). No significant difference in all causes of death was found between the SES and BMS groups, as well as in the pooled recurrent myocardial infarction rates. The pooled recurrent revascularization rate was significantly lower in the SES group than in the BMS group (5.1% vs 14.8%, OR 3.30, 95%Cl 2.37-4.60, P < 0.00001). No significant difference was found between the pooled rates of stent thrombosis (1.2% in the SES group and 2.0% in the BMS group, OR 1.61, 95%Cl 0.79-3.26, P=0.19). Conclusions SES is associated with a decreased risk of major adverse cardiac events compared with BMS by thegreater reduction in repeat revascularization in STEMI patients. Larger trials with longer follow up are warranted to betterdefine the role of SES in STEMI.

  11. The Impact of Trimetazidine Treatment on Left Ventricular Functions and Plasma Brain Natriuretic Peptide Levels in Patients with Non-ST Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention

    OpenAIRE

    Demirelli, Selami; KARAKELLEOĞLU, Şule; Gündoğdu, Fuat; TAŞ, Muhammed Hakan; KAYA, Ahmet; Duman, Hakan; Değirmenci, Hüsnü; Hamur, Hikmet; Şimşek, Ziya

    2013-01-01

    Background and Objectives The aim of this study was to investigate the impact of treatment with oral trimetazidine (TMZ) applied before and after percutaneous coronary interventions (PCI) on short-term left ventricular functions and plasma brain natriuretic peptide (BNP) levels in patients with non-ST segment elevation myocardial infarction (NSTEMI) undergoing PCI. Subjects and Methods The study included 45 patients who were undergoing PCI with the diagnosis of NSTEMI. The patients were rando...

  12. ST段抬高型心肌梗死患者的溶栓治疗与护理%Thrombolytic treatment and nursing of ST segment elevation myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    韩桂枝; 宋爱华; 刘卫民

    2015-01-01

    目的:探讨溶栓治疗急性ST段抬高型心肌梗死(STEMI)的临床疗效及护理。方法:110例急性STEMI患者均给予扩冠、抗凝、抑制血小板等常规治疗,将予溶栓治疗的50例患者作为治疗组,其余患者作为对照组,观察两组患者的临床疗效及不良反应。结果:治疗组存活出院率90.00%,对照组75.00%,差异具有统计学意义(P<0.05)。结论:溶栓治疗急性STEMI疗效确切,及时有效的护理对患者康复起着重要作用。%Objective:To explore the clinical curative effect and nursing of thrombolytic treatment in acute ST segment elevation myocardial infarction(STEMI).Methods:110 patients with acute STEMI were given dilate coronary arteries,anticoagulation,inhibit platelet and other conventional treatment.50 patients were given thrombolytic treatment as the treatment group,and the other patients were as the control group.The clinical curative effects and adverse reactions of two groups were observed.Results:The survival hospital discharge rate of the treatment group was 90.00% ,and the control group was 75.00% .The difference was statistically significant(P<0.05).Conclusion:The curative effect of thrombolysis in the treatment of acute STEMI is definitive.The timely and effective care is important for the rehabilitation of patients.

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

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

    OpenAIRE

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

    1994-01-01

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

  15. Plasma Metabolic Profile Determination in Young ST-segment Elevation Myocardial Infarction Patients with Ischemia and Reperfusion: Ultra-performance Liquid Chromatography and Mass Spectrometry for Pathway Analysis

    Institute of Scientific and Technical Information of China (English)

    Lei Huang; Tong Li; Ying-Wu Liu; Lei Zhang; Zhi-Huan Dong; Shu-Ye Liu; Ying-Tang Gao

    2016-01-01

    Background:This study was to establish a disease differentiation model for ST-segment elevation myocardial infarction (STEMI) youth patients experiencing ischemia and reperfusion via ultra-performance liquid chromatography and mass spectrometry (UPLC/MS) platform,which searches for closely related characteristic metabolites and metabolic pathways to evaluate their predictive value in the prognosis after discharge.Methods:Forty-seven consecutive STEMI patients (23 patients under 45 years of age,referred to here as "youth," and 24 "elderly" patients) and 48 healthy control group members (24 youth,24 elderly) were registered prospectively.The youth patients were required to provide a second blood draw during a follow-up visit one year after morbidity (n =22,one lost).Characteristic metabolites and relative metabolic pathways were screened via UPLC/MS platform base on the Kyoto encyclopedia of genes and genomes (KEGG) and Human Metabolome Database.Receiver operating characteristic (ROC) curves were drawn to evaluate the predictive value of characteristic metabolites in the prognosis after discharge.Results:We successfully established an orthogonal partial least squares discriminated analysis model (R2X =71.2%,R2Y =79.6%,and Q2 =55.9%) and screened out 24 ions; the sphingolipid metabolism pathway showed the most drastic change.The ROC curve analysis showed that ceramide [Cer(d18:0/16:0),Cer(t18:0/12:0)] and sphinganine in the sphingolipid pathway have high sensitivity and specificity on the prognosis related to major adverse cardiovascular events after youth patients were discharged.The area under curve (AUC) was 0.671,0.750,and 0.711,respectively.A follow-up validation one year after morbidity showed corresponding AUC of 0.778,0.833,and 0.806.Conclusions:By analyzing the plasma metabolism of myocardial infarction patients,we successfully established a model that can distinguish two different factors simultaneously:pathological conditions and age

  16. Admission lipoprotein-associated phospholipase A2 activity is not associated with long-term clinical outcomes after ST-segment elevation myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Pier Woudstra

    Full Text Available BACKGROUND: Lipoprotein-associated phospholipase A2 (Lp-PLA2 activity is a biomarker predicting cardiovascular diseases in a real-world. However, the prognostic value in patients undergoing primary percutaneous coronary intervention (pPCI for ST-segment elevation myocardial infarction (STEMI on long-term clinical outcomes is unknown. METHODS: Lp-PLA2 activity was measured in samples obtained prior to pPCI from consecutive STEMI patients in a high-volume intervention center from 2005 until 2007. Five years all-cause mortality was estimated with the Kaplan-Meier method and compared among tertiles of Lp-PLA2 activity during complete follow-up and with a landmark at 30 days. In a subpopulation clinical endpoints were assessed at three years. The prognostic value of Lp-PLA2, in addition to the Thrombolysis In Myocardial Infarction or multimarker risk score, was assessed in multivariable Cox regression. RESULTS: The cohort (n = 987 was divided into tertiles (low 179 nmol/min/mL. Among the tertiles differences in baseline characteristics associated with long-term mortality were observed. However, no significant differences in five years mortality in association with Lp-PLA2 activity levels were found; intermediate versus low Lp-PLA2 (HR 0.97; CI 95% 0.68-1.40; p = 0.88 or high versus low Lp-PLA2 (HR 0.75; CI 95% 0.51-1.11; p = 0.15. Both in a landmark analysis and after adjustments for the established risk scores and selection of cases with biomarkers obtained, non-significant differences among the tertiles were observed. In the subpopulation no significant differences in clinical endpoints were observed among the tertiles. CONCLUSION: Lp-PLA2 activity levels at admission prior to pPCI in STEMI patients are not associated with the incidence of short and/or long-term clinical endpoints. Lp-PLA2 as an independent and clinically useful biomarker in the risk stratification of STEMI patients still remains to be proven.

  17. 急性心肌梗死经急诊PCI后心电图ST段下降幅度与糖化血红蛋白相关性研究%Correlation study on the ECG ST segment decreased range and glycosylated hemoglobin of acute myocardial infarction after emergency PCI

    Institute of Scientific and Technical Information of China (English)

    陈玉兰

    2015-01-01

    目的:探讨急性心肌梗死患者经急诊PCI治疗后心电图ST段下降幅度与糖化血红蛋白的相关性。方法:收治急性心肌梗死患者69例,经急诊PCI治疗成功,比较患者入院时及术后1 h的ECG,根据抬高的ST段下降的幅度将患者分为A、B两组:A组为ST段下降≥50,B组为ST段下降<50;测定所有患者的糖化血红蛋白值,观察并比较ST 段下降幅度与糖化血红蛋白的相关性。结果:经急诊 PCI 治疗后,A 组心电图抬高的 ST 段下降幅度明显高于 B组,糖化血红蛋白明显低于B组(P<0.05);A组糖尿病患者明显少于B组(P<0.05)。结论:急性心肌梗死患者经急诊PCI治疗后心电图ST段下降幅度与糖化血红蛋白值密切相关,可将糖化血红蛋白值作为急性心肌梗死早期干预治疗的有效指标。%Objective:To explore the correlation of the ECG ST segment decreased range and glycosylated hemoglobin of patients with acute myocardial infarction after emergency PCI treatment.Methods:69 patients with acute myocardial infarction were selected.They had successful treatment after emergency PCI.The ECG of patients on admission and postoperative 1 hour were compared.The patients were divided into A,B two groups according to the decreased range of the elevated ST segment.The ST segment decreased range was more than or equal to 50 as A group,the ST segment decreased range was less than 50 as B group. The glycosylated hemoglobin values of all patients were measured.The correlation of the ST segment decreased range and glycosylated hemoglobin was observed and compared.Results:After emergency PCI treatment,the ECG elevated ST segment decreased range of A group was significantly higher than that of B group,the glycosylated hemoglobin was lower than that of B group(P<0.05).The diabetic patients of A group was significantly less than that of B group(P<0.05).Conclusion:The ECG ST segment decreased range and glycosylated

  18. Clinical implications of ST-segment non-resolution after thrombolysis for myocardial infarction.

    Science.gov (United States)

    Bhatia, L; Clesham, G J; Turner, D R

    2004-12-01

    Failed reperfusion after thrombolytic therapy for acute myocardial infarction is common and signifies a poor prognosis. We investigated the clinical consequences of non-resolution of the ST segment after thrombolytic therapy for acute ST-elevation myocardial infarction, in 85 consecutive patients admitted to a coronary care unit lacking rapid access to angioplasty. Failed thrombolysis was defined as <50% ST-segment resolution 180 minutes after the start of thrombolytic treatment. Outcomes were measured in terms of in-hospital adverse events, length of hospital stay, and mortality at 6 weeks and 1 year. Thrombolysis was successful, in terms of ST-segment resolution, in 45 patients (53%). After adjustment for other factors, ST resolution was the only independent predictor of an uncomplicated recovery in hospital (odds ratio 6.8, 95% confidence interval 2.3 to 19.9; P<0.001). At 6 weeks and 1 year, overall mortality was lower in the ST resolution group, though these differences became non-significant on multivariate analysis. In patients who survived to hospital discharge, median length of stay was greater in successfully thrombolysed patients (9 days versus 8 days) despite their lower rate of complications. ST-segment resolution is a useful marker of successful thrombolysis and relates to clinical outcome. If assessed routinely it might assist, along with other clinical markers, in the identification of low-risk patients who can be discharged early.

  19. A single center, open, randomized study investigating the clinical safety and the endothelial modulating effects of a prostacyclin analog in combination with eptifibatide in patients having undergone primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction

    DEFF Research Database (Denmark)

    Holmvang, Lene; Ostrowski, Sisse Rye; Dridi, Nadia Paarup;

    2012-01-01

    Treatment with the endothelial modulator prostacyclin may be beneficial in patients with endothelial dysfunction. The primary aim of the present pilot study was to evaluate the safety and the potential endothelial modulating affect of the prostacyclin analog iloprost in patients with a recent ST...... segment elevation myocardial infarction (STEMI). Seventeen patients were randomized to either 24h of iloprost infusion in combination with low dose eptifibatide infusion or saline infusion+eptifibatide. The study was randomized and open labeled. None of the patients experienced any bleeding complications...... activated endothelium in patients with a recent STEMI. ClinicalTrials.gov: NCT01179776....

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

    NARCIS (Netherlands)

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

    2010-01-01

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

  1. 血浆N末端脑钠肽前体联合全球急性冠状动脉事件注册评分建立非ST段抬高型急性冠状动脉综合征临床风险预测模型的研究%Addition of N-terminal pro-brain natriuretic peptide to the Global Registry of Acute Coronary Events risk stratification to predict outcome in non-ST-segment elevation acute coronary syndrome

    Institute of Scientific and Technical Information of China (English)

    张宁; 刘文娴

    2014-01-01

    Objective To build a composite score based on the Global Registry of Acute Coronary Events (GRACE) score and N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations to predict outcome in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Methods Patients with NSTE-ACS in Beijing Anzhen Hospital affiliated to capital medical university, a composite score including the GRACE score and NT-proBNP concentrations was first randomly developed in a retrospective cohort of 409 patients with NSTE-ACS and then validated in a prediction model of other 231 patients. The mean follow- up time in a retrospective cohort were (774±217) days, and in a prediction model were (706±231)days. The primary end point was the composite of MACE, defined as cardiogenic deaths, myocardial infarction, readmission for heart failure. Results The patients were reclassified by the composite score, 105 patients were in low risk group, 209 patients were in medium risk group, and 95 patients were in high risk group. End points were reached in 26 patients (6.6%). The lgNT-proBNP in patients with NSTE-ACS had positive correlation with their GRACE risk score (r=0.507, P170 was high risk group. 10 patients would be reclassified at high risk using the composite score despite being classified at low risk using the GRACE score alone. Alternatively, 7 patients would be reclassified at medium risk, while being classified high risk with the GRACE score alone. 8 patients would be reclassified at low risk using the composite score despite being classified at high risk using the GRACE score alone. Finally, 2 patients while being classified medium risk of reached the end points, that was would be reclassified at high risk. 6.5% of the population in prediction model reached the end points. The use of the composite score increased the accuracy of the GRACE score, with an increase in the under-ROC curve area from 0.748 to 0.762. Conclusion Both NT-proBNP concentration and GRACE

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

    OpenAIRE

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

    2013-01-01

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

  3. Fibrinolytic Therapy Versus Primary Percutaneous Coronary Interventions for ST-Segment Elevation Myocardial Infarction in Kentucky: Time to Establish Systems of Care?

    Science.gov (United States)

    Wallace, Eric L.; Kotter, John R.; Charnigo, Richard; Kuvlieva, Liliana B.; Smyth, Susan S.; Ziada, Khaled M.; Campbell, Charles L.

    2013-01-01

    Background Fibrinolytic therapy is recommended for ST-segment myocardial infarctions (STEMI) when primary percutaneous coronary intervention (PPCI) is not available or cannot be performed in a timely manner. Despite this recommendation, patients often are transferred to PPCI centers with prolonged transfer times, leading to delayed reperfusion. Regional approaches have been developed with success and we sought to increase guideline compliance in Kentucky. Methods A total of 191 consecutive STEMI patients presented to the University of Kentucky (UK) Chandler Medical Center between July 1, 2009 and June 30, 2011. The primary outcome was in-hospital mortality and the secondary outcomes were major adverse cardiovascular events, extent of myocardial injury, bleeding, and 4) length of stay. Patients were analyzed by presenting facility—the UK hospital versus an outside hospital (OSH)—and treatment strategy (PPCI vs fibrinolytic therapy). Further analyses assessed primary and secondary outcomes by treatment strategy within transfer distance and compliance with American Heart Association guidelines. Results Patients presenting directly to the UK hospital had significantly shorter door-to-balloon times than those presenting to an OSH (83 vs 170 minutes; P P = 0.45). Overall, only 20% of OSH patients received timely reperfusion, 13% PPCI, and 42% fibrinolytics. In a multivariable model, delayed reperfusion significantly predicted major adverse cardiovascular events (odds ratio 3.87, 95% confidence interval 1.15–13.0; P = 0.02), whereas the presenting institution did not. Conclusions In contemporary treatment of STEMI in Kentucky, ongoing delays to reperfusion therapy remain regardless of treatment strategy. For further improvement in care, acceptance of transfer delays is necessary and institutions should adopt standardized protocols in association with a regional system of care. PMID:23820318

  4. Intracoronary Compared to Intravenous Bolus Abciximab during Primary Percutaneous Coronary Intervention in ST-segment Elevation Myocardial Infarction (STEMI) Patients Reduces 30-day Mortality and Target Vessel Revascularization: A Randomized Trial

    DEFF Research Database (Denmark)

    Iversen, Allan; Abildgaard, Ulrik; Galloe, Anders;

    2011-01-01

    Background: Abciximab is beneficial in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). However, the optimal administration route of the initial bolus of abciximab, that is, intravenous (IV) versus intracoronary (IC), has...... been questioned. Preliminary studies suggest that IC-bolus is superior, probably due to high local concentration. In this study, we assess the short-term efficacy and safety of IC compared to IV bolus of abciximab in patients with STEMI during pPCI. Methods: In 2006-2008, we randomized 355 STEMI...... patients who underwent pPCI and had indication for abciximab to either IV or IC bolus followed by a 12-hour IV infusion. Primary end-points at 30 days were target vessel revascularization (TVR), recurrent myocardial infarction (MI) or death, and the composite of the three. Secondary end-points were...

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

    Institute of Scientific and Technical Information of China (English)

    汪海涛; 郭敏

    2011-01-01

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

  6. ST-segment elevation myocardial infarction in a 37-year-old man with normal coronaries--it is not always cocaine!

    Science.gov (United States)

    Arora, Shitij; Goyal, Hemant; Aggarwal, Prachi; Kukar, Atul

    2012-11-01

    Heart disease is one of the leading causes of death in the United States. With the increase in substance abuse, the incidence of acute myocardial infarction (MI) in younger population has been on the rise. Traditionally, cocaine has been blamed for acute MI; however, recently, there have been more incidences of marijuana as an inciting factor. We present a case of marijuana-induced acute MI and discuss the proposed mechanism. PMID:22306387

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

    DEFF Research Database (Denmark)

    Iversen, Kasper; Dalsgaard, Morten; Teisner, Ane S;

    2009-01-01

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

  8. Impact of the time course of reperfusion on early outcomes in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention%急诊经皮冠状动脉介入术开通梗死相关血管时程变化对急性ST段抬高型心肌梗死早期预后的影响

    Institute of Scientific and Technical Information of China (English)

    徐广马; 胡昌兴; 林英忠; 刘伶; 覃绍明; 伍广伟; 林虹

    2011-01-01

    Objective:To observe the impact of treatment delays on early outcomes in patients with acute STsegment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI).Method:Two hundred and thirteen patients were stratified on the basis of their time delays: from symptom onset until balloon inflation. The patients were divided into 3 groups: group A (27 patients)-time from symptom onset ≤180 min; group B (83 patients)-time delays of 180-360 min; group C (103 patients)-time from symptom onset >360 min. During a 30 day follow-up, the major adverse cardiac event such as non-fatal reinfarction and cardiogenic shock and the cardiogenic mortality were recorded. Result: The median time delay was (355. 3 ± 223) min.The patients with longer time delays (groupC) were older, more often were women,and had a higher frequency of anterior MI and Killip class 4. During hospitalization 29 (13.6%) patients died. In hospital mortality was significantly higher in group C (17.5 %) than in other groups. Complications of STEMI such as cardiogenic shock con siderably influenced mortality (36.5 %). During a 30-day follow-up, the patients with cardiogenic shock and the elderly had an increased risk of cardiac events. Also, time delays >360 min was independent adverse risk factors in multivariate regression analysis. Conclusion:Time delays of pPCI have an important impact on early outcomes,especially in those treated >6 hours from the onset of symptoms.%目的:观察急诊经皮冠状动脉介入术(PCI)开通梗死相关血管的时程变化对急性ST段抬高型心肌梗死(STEMI)住院期间死亡率及心肌梗死后30 d内心血管事件发生率的影响.方法:急性STEMI患者213例,根据症状发生至第1次球囊扩张的时间分为3组:<180 min组(A组,27例),180~360 min组(B组,83例),>360 min组(C组,103例).观察各组术后30 d内主要心血管不良事件的发生率,包括心源性死亡、非致死性心肌梗

  9. Impact of the Residual SYNTAX Score on Outcomes of Revascularization in Patients with ST-Segment Elevation Myocardial Infarction and Multivessel Disease

    OpenAIRE

    Mohamed Loutfi; Sherif Ayad; Mohamed Sobhy

    2016-01-01

    Primary percutaneous coronary intervention (P-PCI) has become the preferred reperfusion strategy in ST-elevation myocardial infarction (STEMI) when performed by an experienced team in a timely manner. However, no consensus exists regarding the management of multivessel coronary disease detected at the time of P-PCI. AIM The aim of this study was to evaluate the use of the residual SYNTAX score (rSS) following a complete vs. culprit-only revascularization strategy in patients with STEMI and mu...

  10. Long-term outcomes for women versus men with unstable angina/non-ST-segment elevation myocardial infarction managed medically without revascularization

    DEFF Research Database (Denmark)

    Clemmensen, Peter; Roe, Matthew T; Hochman, Judith S;

    2015-01-01

    : Compared with men, women were older, weighed less, were less likely to have prior myocardial infarction or revascularization, and had lower baseline creatinine clearance and hemoglobin level values. Rates of the composite of cardiovascular death/myocardial infarction/stroke (20.2% vs 19.1%; P = .56), all......BACKGROUND: Women with acute coronary syndromes (ACS) are less likely to undergo invasive revascularization than men, but sex-specific differences in long-term outcomes and platelet reactivity among medically managed ACS patients remain uncertain. We examined sex-specific differences in long......-term ischemic and bleeding outcomes and platelet reactivity for medically managed ACS patients randomized to prasugrel versus clopidogrel plus aspirin. METHODS: Data from 9,326 patients enrolled in TRILOGY ACS were analyzed to determine differences in long-term ischemic and bleeding outcomes between women (n...

  11. Influence of manual thrombus aspiration on left ventricular diastolic function in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Ilić Ivan

    2016-01-01

    Full Text Available Introduction. Data on effects of thrombus aspiration on left ventricular diastolic function in ST-elevation myocardial infarction (STEMI population are scarce. Objective. We sought to compare echocardiographic indices of the diastolic function and outcomes in STEMI patients treated with and without manual thrombus aspiration, in an academic, high-volume percutaneous coronary intervention (PCI center. Methods. A total of 433 consecutive patients who underwent primary PCI in 2011-2012 were enrolled in the study. Patients were not eligible for the study if they already suffered a myocardial infarction, had been previously revascularized, received thrombolytics, presented with cardiogenic shock, had significant valvular disease, atrial fibrillation or had previously implanted pacemaker. Comprehensive echocardiogram was performed within 48 hours. During follow-up patients’ status was assessed by an office visit or telephone interview. Results. Patients treated with thrombus aspiration (TA+, n=216 had similar baseline characteristics as those without thrombus aspiration (TA-, n=217. Groups had similar total ischemic time (319 ± 276 vs. 333±372 min; p=0.665, but TA+ group had higher maximum values of troponin I (39.5 ± 30.5 vs. 27.6 ± 26.9 ng/ml; p15, as a marker of severe diastolic dysfunction (TA+ 23.1% vs. TA- 15.2%; p=0.050. During average follow-up of 14Ѓ}5 months, major adverse cardiac/ cerebral events occurred at the similar rate (log rank p=0.867. Conclusion. Thrombus aspiration is associated with a greater incidence of severe diastolic dysfunction in unselected STEMI patients treated with primary PCI, but it doesn’t influence the incidence of major adverse cardiovascular events. [Projekat Ministarstva nauke Republike Srbije, br. 175099

  12. Predictors of thrombus burden and no-reflow of infarct-related artery in patients with ST-segment elevation myocardial infarction: importance of platelet indices.

    Science.gov (United States)

    Cakici, Musa; Cetin, Mustafa; Balli, Mehmet; Akturk, Erdal; Dogan, Adnan; Oylumlu, Muhammed; Abus, Sabri; Yildiz, Emrah; Sungur, Azmi; Celiker, Meral

    2014-10-01

    Preprocedural high-thrombus burden (HTB) of infarct-related artery (IRA) is a harbinger of procedural complications following primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). The HTB of IRA can lead to poor outcomes by various mechanisms, including no-reflow phenomenon, increased myocardial necrosis and with subsequent reduced survival benefit at follow-up. In this study, we investigated the relationship between all platelet indices on admission and thrombus burden and the no-reflow phenomenon after primary PCI of IRA in patients with STEMI. We retrospectively enrolled 475 patients with STEMI undergoing primary PCI. Study population was divided into two groups according to the thrombolysis in myocardial infarction thrombus grade of IRA as low-thrombus burden or HTB. There were no statistically significant differences in platelet indices, including platelet count, platelet-large cell ratio (P-LCR), mean platelet volume (MPV) and platelet distribution with (PDW) among the groups. However, in the subgroup analysis, P-LCR, MPV and PDW were significantly higher in the no-reflow patients than reflow patients despite similar platelet count (P for all < 0.001). The cutoff value of P-LCR for predicting no-reflow was 26.5% with a sensitivity of 67.0% and a specificity of 62% (area under the curve, 0.689; 95% confidence interval, 0.614-0.765; P < 0.001). Furthermore, P-LCR, MPV and PDW had similar AUC (0.689, P < 0.001; 0.688, P < 0.001; and 0.677, P < 0.001; respectively) for predicting no-reflow phenomenon after primary PCI. As a result, all of the platelet indices have no effect on thrombus load of IRA, however, these parameters seem to impair epicardial perfusion after primary PCI. PMID:24806326

  13. 非ST段抬高急性冠脉综合征患者随机应用依诺肝素或普通肝素抗凝治疗的疗效和出血并发症系统综述%Efficacy and Bleeding Complications Among Patients Randomized to Enoxaparin or Unfractionated Heparin for Antithrombin Therapy in Non-ST-Segment Elevation Acute Coronary Syndromes A Systematic Overview

    Institute of Scientific and Technical Information of China (English)

    John L. Petersen; James A. de Lemos; Christopher C. Nessel; Robert A. Harrington; James J. Ferguson; Eugene Braunwald; Robert M. Califf; 徐成斌; Kenneth W. Mahaffey; Vic Hasselblad; Elliott M. Antman; Marc Cohen; Shaun G. Goodman; Anatoly Langer; Michael A. Blazing; Anne Le-Moigne-Amrani

    2005-01-01

    背景:抗凝疗法已成为急性冠脉综合征(acute coronary syndrome,ACS)治疗指南推荐的标准疗法.但是,最近某些试验在ACS患者中对依诺肝素(enoxaparin)与普通肝素(unfractionated heparin)的应用进行了比较,发现这些抗凝疗法的疗效及安全性并不及既往试验结果.目的:有6项随机对照试验对依诺肝素与普通肝素治疗ACS患者进行了比较,对其终点(即全因死亡及非致死性心肌梗死)、输血与大出血进行系统评估.资料来源:从杜克临床研究所(Duke Clinical Research Institute)获取ESSENCE、A to Z及SYNERGY试验的原始数据.由TIMI 11B、ACUTEⅡ及INTERACT研究的主要研究人员提供各自的基线特征和事件发生频率.研究选取:在非ST段抬高ACS患者中比较依诺肝素与普通肝素的6项随机对照试验均入选进行分析.数据提取:从全部试验人群和随机分组前未接受抗凝治疗的亚人群中获取疗效终点和安全性终点.数据综合:应用随机效应经验性贝叶斯模型(random-effects empirical Bayes model),系统评估21 946例患者的结果.依诺肝素与普通肝素30天死亡率无显著差异(3.0%比3.0%,优势比[odds ratio,OR],1.00;95%可信区间[confidence interval,CI],0.85~1.17).在所有试验人群中,依诺肝素与普通肝素相比,30天死亡或非致死性心肌梗死(myocardial infarction,MI)联合终点显著下降,具有统计学差异(10.1%比11.0%;OR,0.91;95%CI,0.83~0.99;所需治疗例数107).随机分组前未接受抗凝治疗的依诺肝素组患者30天死亡或MI联合终点亦显著下降,具有统计学差异(8.0%比9.4%;OR,0.81;95%CI,0.70~0.94;所需治疗例数72).随机分组后第7天,总体安全人群或者随机分组前未接受抗凝治疗的人群输血(OR,1.01;95%CI,0.89~1.14)或大出血的发生率(OR,1.04;95%CI,0.83~1.30)无显著差异.结论:对近22 000例各类ACS患者进行系统回顾发现,在预防死亡或MI联合终点方面依诺肝素较普通肝素更有效.

  14. Heart rate at discharge and long-term prognosis following percutaneous coronary intervention in stable and acute coronary syndromes — results from the BASKET PROVE trial

    DEFF Research Database (Denmark)

    Jensen, Magnus Thorsten; Kaiser, Christoph; Sandsten, Karl Erik;

    2013-01-01

    Elevated heart rate (HR) is associated with mortality in a number of heart diseases. We examined the long-term prognostic significance of HR at discharge in a contemporary population of patients with stable angina (SAP), non-ST-segment elevation acute coronary syndromes (NSTE-ACS), and ST......-segment elevation myocardial infarction (STEMI) revascularized with percutaneous coronary intervention (PCI)....

  15. Factors associated with delay of reperfusion-decision for patients with ST-segment elevation myocardial infarction%影响ST段抬高心肌梗死患者再灌注决定延迟的因素

    Institute of Scientific and Technical Information of China (English)

    宋莉; 颜红兵; 杨进刚; 孙艺红; 刘书山; 李超; 胡大一

    2010-01-01

    目的 调相急性ST段抬高心肌梗死(STEMI)患者的再灌注决定延迟程度并分析其影响因素.方法 本研究为多中心现况调查.入选2006年1月1日至12月31日期间就诊于北京市19所医院并接受心肌再灌注治疗的635例急性STEMI患者.入院1周内,通过与患者进行结构式访谈及查阅病例记录收集资料.再灌注决定延迟定义为院内完成首份心电图至患者或家属签署治疗同意书的时间间隔.根据再灌注决定延迟时间分为早决定组(≤30 min)和晚决定组(>30 min),采用单凶素和多因素分析识别影响再灌注决定延迟的相关凶素.结果 接受溶栓者129例(20.3%),接受直接PCI者506例(79.7%).中位再灌注决定延迟时间为47 min,中位进门-溶栓时间为82 min,中位进门-球囊扩张时间为135 min.多元logistic回归分析显示,了解再灌注治疗(OR=1.723,95%CI:1.156~3.212,P=0.040)、有院前心电图(OR=1.566,95% CI:1.018~2.409,P=0.036)、入院时心功能Killip分级≥2(OR=1.579,95% CI:1.004~2.483,P=0.021)以及就诊于心血管专科医院(OR=5.075,95%CI:1.380~18.655,P=0.014)是再灌注决定延迟≤30 min的独立预测因素.早决定组的中位进门-溶栓时间(47 min比103 min,P<0.001)和中位进门-球囊扩张时间(100 min比154min,P<0.001)明显短于晚决定组.结论 STEMI的再灌注决定延迟时间偏长,是院内延迟的主要部分.普及再灌注治疗知识以及通过救护车转运增加院前心电图完成率可能缩短院内延迟.%Objective To determine lengths and factors associated with delay of reperfusiondecision in patients with acute ST-segment elevation myocardial infarction (STEMI).Methods This crosssectional and multicenter survey was conducted in 19 hospitals from Beijing between 1 January and 31 December,2006 and included STEMI patients receiving thrombolysis or primary percutaneous coronary intervention (PCI).Data were collected by structured interviews and medical records

  16. Safety and feasibility of performing staged non-culprit vessel percutaneous coronary intervention within the index hospitalization in patients with ST-segment elevation myocardial infarction and multivessel disease

    Energy Technology Data Exchange (ETDEWEB)

    Loh, Joshua P.; Kitabata, Hironori; Torguson, Rebecca; Satler, Lowell F.; Kent, Kenneth M.; Suddath, William O.; Pichard, Augusto D.; Lindsay, Joseph; Waksman, Ron, E-mail: ron.waksman@medstar.net

    2013-09-15

    Objectives: To determine whether staged percutaneous coronary intervention (PCI) within the same hospitalization as primary PCI is safe. Background: In ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease undergoing primary PCI, staged non-culprit vessel PCI at a separate session is recommended. Methods: We conducted a retrospective analysis of 282 consecutive STEMI patients with multivessel disease who underwent primary PCI followed by staged PCI of the non-culprit vessel. Patients were categorized into staged PCI in the same hospitalization (n = 184) and staged PCI at a separate hospitalization within 8 weeks of primary PCI (n = 98). Results: Baseline characteristics, presentation of STEMI, and procedural characteristics were similar in both groups. Contrast amount was higher in the separate hospitalization group for both index (175 vs. 153 ml, p = 0.011) and staged (144 vs. 120 ml, p = 0.004) procedures. More staged left main PCI was performed in the separate hospitalization group (3.9 vs. 0.3%, p = 0.008). Angiographic success of staged PCI was similar in both groups, with similar rates of vascular complications and major bleeding. Following staged PCI, in-hospital major adverse cardiac events (3.3 vs. 1.0%, p = 0.43) and mortality (2.7 vs. 0%, p = 0.17) were similar in both groups. Conclusions: Our study supports the safety and feasibility of staged PCI within the same hospitalization as primary PCI, achieving similar procedural success and in-hospital outcomes as staged PCI at a separate hospitalization. Higher contrast amount used during primary PCI and presence of left main lesion in non-culprit vessels may influence the decision to stage the PCI at a separate hospitalization.

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

    OpenAIRE

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

    2012-01-01

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

  18. Effectiveness of a multidisciplinary critical pathway based on a computerised physician order entry system for ST-segment elevation myocardial infarction management in the emergency department: a retrospective observational study

    Science.gov (United States)

    Park, Yoo Seok; Chung, Sung Phil; You, Je Sung; Kim, Min Joung; Chung, Hyun Soo; Hong, Jung Hwa; Lee, Hye Sun; Wang, Jinwon; Park, Incheol

    2016-01-01

    Objectives The purpose of this study was to investigate whether a multidisciplinary organised critical pathway (CP) for ST-segment elevation myocardial infarction (STEMI) management can significantly attenuate differences in the duration from emergency department (ED) arrival to evaluation and treatment, regardless of the arrival time, by eliminating off-hour and weekend effects. Design Retrospective observational cohort study. Setting 2 tertiary academic hospitals. Participants Consecutive patients in the Fast Interrogation Rule for STEMI (FIRST) program. Interventions A study was conducted on patients in the FIRST program, which uses a computerised physician order entry (CPOE) system. The patient demographics, time intervals and clinical outcomes were analysed based on the arrival time at the ED: group 1, normal working hours on weekdays; group 2, off-hours on weekdays; group 3, normal working hours on weekends; and group 4, off-hours on weekends. Primary and secondary outcome measures Clinical outcomes categorised according to 30-day mortality, in-hospital mortality and the length of stay. Results The duration from door-to-data or FIRST activation did not differ significantly among the 4 groups. The median duration between arrival and balloon placement during percutaneous coronary intervention did not significantly exceed 90 min, and the proportions (89.6–95.1%) of patients with door-to-balloon times within 90 min did not significantly differ among the 4 groups, regardless of the ED arrival time (p=0.147). Moreover, no differences in the 30-day (p=0.8173) and in-hospital mortality (p=0.9107) were observed in patients with STEMI. Conclusions A multidisciplinary CP for STEMI based on a CPOE system can effectively decrease disparities in the door-to-data duration and proportions of patients with door-to-balloon times within 90 min, regardless of the ED arrival time. The application of a multidisciplinary CP may also help attenuate off-hour and weekend

  19. 2001-2011年中国东部城市ST段抬高型心肌梗死诊疗趋势%ST-segment elevation myocardial infarction in the eastern urban China: from 2001 to 2011

    Institute of Scientific and Technical Information of China (English)

    李静; 李希; 胡爽; 余苑; 严小芳; 蒋立新

    2016-01-01

    Objective To assess trends in clinical characteristics,treatments,and outcomes for hospitalized patients with ST-segment elevation myocardial infarction (STEMI) in eastern urban China from 2001 to 2011.Methods The data were obtained from the China PEACE-retrospective acute myocardial infarction study.Patients admitted to hospital in the eastern urban China for STEMI were selected via twostage random sampling.The first phase was to identify participating hospitals via a simple random-sampling procedure.The second stage was to select patients admitted to each participating hospitals for acute myocardial infarction in the year of 2001,2006 and 2011 with a systematic sampling approach.Then clinical information was obtained via central medical record abstraction for each patient.In all analyses,weight was calculated proportional to the inverse sampling fraction for each period.Multilevel logistic regression models with generalized estimating equations were used for analysis of patient outcomes.Results This analysis included 5 257 patients with STEMI from 32 hospitals.In 2001,2006,and 2011,the median age of STEMI patients was 66 (57,72) 、67 (56,74) and 63 (53,74) years (trend test P =0.008),the proportion of female was 30.3%,29.5% and 29.2% (trend test P =0.530),respectively.The proportion of cardiovascular risk factors increased over time(trend test P <0.001);45.6%,55.6%,and 56.3% patients had hypertension (trend test P < 0.001);18.8%,27.7% and 26.2% patients had diabetes (trend test P < 0.001);50.1%,59.2% and 70.5% patients had dyslipidemia (trend test P < 0.001);30.5%,35.1% and 44.1% patients are current smokers(trend test P < 0.001) in 2001,2006 and 2011,respectively.Between 2001 and 2011,there were significant increases in aspirin use (80.7% in 2001,90.4% in 2006,and 91.5% in 2011,trend test P <0.001),clopidogrel use(2.9% in 2001,64.2% in 2006,and 90.3% in 2011,trend test P <0.001) within 24 hours after

  20. Aneurysm of the left aortic sinus causing acute myocardial infarction

    International Nuclear Information System (INIS)

    This report describes the findings and management of a young male who presented with an acute ST-segment elevation myocardial infarction due to compression of the circumflex coronary artery by a large aneurysm of left sinus of Valsalva

  1. Aneurysm of the left aortic sinus causing acute myocardial infarction

    OpenAIRE

    Jan-Peter Smedema; Vernon Freeman; Johan Brink

    2011-01-01

    This report describes the findings and management of a young male who presented with an acute ST-segment elevation myocardial infarction due to compression of the circumflex coronary artery by a large aneurysm of left sinus of Valsalva.

  2. 平板运动试验致ST段抬高与继发室性心律失常和心肌梗死关系探讨(附29例分析)%Study of the correlations between exercise treadmill test induced ST-segment elevation and secondary ventricular arrhythmia and myocardial infarction by analysis of 29 cases

    Institute of Scientific and Technical Information of China (English)

    万进; 章亚成; 李七一; 王光耀; 史海波; 杨宗美; 唐蜀华

    2011-01-01

    目的:分析无陈旧性心肌梗死患者运动诱发的ST段抬高现象,比较ST段抬高和继发室性心动过速、心肌梗死的关系,找出预警指标.方法:对9900例疑似冠心病者行平板运动试验检查,阳性人数3002例.同时检出ST段抬高者29例,并对其行冠状动脉造影检查,比较ST抬高程度、冠状动脉狭窄、T波顶峰后宽度(TaTe)、T波顶峰后宽度/QT间期(TaTe/QT)、QT离散度(QTd)、修正的QT离散度(QTcd)、室性期前收缩(RONT,室早)和症状之间存在的内在联系.结果:发现9900例检查者中阳性率30.32%;ST段抬高发生率为0.29%.4例并发心肌梗死,5例并发室性心动过速.同时发现,ST段抬高程度、形态、冠状动脉狭窄、伴发的室性心动过速、心肌梗死、TaTe、TaTe/QT、QTd、QTcd、RONT及症状之间存在正向关系,室性心动过速时TaTe/QT与无心律失常组比较差异有统计学意义(P<0.001).结论:无心肌梗死者运动诱发心电图ST段抬高,提示冠状动脉存在严重固定狭窄或/并痉挛,并与心肌梗死、室性心动过速有并行关系,尤其TaTe/QT比值,是最有预警可能发生室速的重要价值.%Objective;To analyze the correlation between exercise-induced ST-segment elevation,secondary ventricular arrhythmia and myocardial infarction( MI) in patients with no previous MI history, and to further identify early warning indicators. Methods: Nine thousand nine hundred suspected coronary heart disease (CHD) patients who were examined with exercise treadmill test(ETT) in our hospital between January 2002 and October 2010 were reviewed. FIT was carried out in Bruce protocol with submaximal exercise, and ST-segment depression of at least 0. 1mV for 0. 08 second after the J point (ST-segment standard) was set positive, positive rate is 30. 32%. Among all the patients, twenty nine cases were found with positive exercise-induced ST elevation. The features of elevated ST-segment were analyzed in relation

  3. 非ST段抬高心肌梗死预后的影响因素分析%Investigation of factors influencing prognosis of patients with non-ST-segment elevation myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    刘广彬; 彭永平; 江时森

    2011-01-01

    摘要:目的 分析影响非ST段抬高心肌梗死(NSTEMI)预后的相关因素及有效的治疗策略.方法 收集2001年1月~2010年1月资料完整的NSTEMI患者206例,随访≥6个月,以随访6个月和2年的预后分别为近期和远期预后,记录心血管事件,包括主要终点事件(心源性死亡)和联合终点事件[心源性死亡和(或)非致死性心肌梗死],应用Cox生存模型对影响预后的多因素进行分析.结果 142例完成6个月随访,共发生心血管事件20例,其中心源性死亡16例(11.27%)、非致死性心肌梗死4例(2.82%);93例完成2年随访,共发生心血管事件20例,其中心源性死亡15例(16.13%)、非致死性心肌梗死5例(5.38%).影响患者近期预后的因素为年龄、心力衰竭、肾功能不全、阿司匹林,影响患者远期预后的因素为年龄、心力衰竭、肾功能不全、阿司匹林、早期PCI.结论 NSTEMI患者预后不佳,年龄、心力衰竭、肾功能不全是最重要的危险因素,而阿司匹林是重要的保护因素,早期PCI可显著改善患者的远期预后.%Objective To evaluate the prognostic factors and the effective treatment strateges in patients with non-ST-segment elevation myocardial infarction (NSTEMI). Methods 206 patients with NSTEMI were selected from the Department of Cardiology of our hospital during January 2001 to January 2010. The patients were followed up for 6 months to 2 years. The primary end point was cardiac death and the combined end point was a composite of cardiac death and nonfatal myocardial infarction. Cox regression model was used to analyze the association between risk factors and combined end points. Results 142 patients finished the 6-months follow up,20 cardiovascular events occurred,including 16(11. 27%) cardiac death and 4(2. 82%) myocardial infarction. 93 patients finished the 2-years follow up,there were also 20 cardiovascular events,including 15 cardiac death and 5 myocardial infarction. The most

  4. Usefulness of preprocedure high-sensitivity C-reactive protein to predict death, recurrent myocardial infarction, and stent thrombosis according to stent type in patients with ST-segment elevation myocardial infarction randomized to bare metal or drug-eluting stenting during primary percutaneous

    DEFF Research Database (Denmark)

    Schoos, Mikkel Malby; Kelbæk, Henning; Kofoed, Klaus F;

    2011-01-01

    It is unknown whether high-sensitivity C-reactive protein (hs-CRP) predicts outcome depending on implanted stent type. We investigated the prognostic value of hs-CRP in relation to type of stent implanted in patients with ST-segment elevation myocardial infarction (STEMI). Immediately before...... primary percutaneous coronary intervention (pPCI), 301 patients had blood drawn. Patients were categorized according to hs-CRP levels and combination of hs-CRP (=2 vs >2 mg/L) and stent type (bare metal stent [BMS] vs drug-eluting stent [DES]). Hs-CRP >2 mg/L (median, hazard ratio 2.7, 95% confidence...

  5. Usefulness of preprocedure high-sensitivity C-reactive protein to predict death, recurrent myocardial infarction, and stent thrombosis according to stent type in patients with ST-segment elevation myocardial infarction randomized to bare metal or drug-eluting stenting during primary percutaneous

    DEFF Research Database (Denmark)

    Schoos, Mikkel Malby; Kelbæk, Henning; Kofoed, Klaus F;

    2011-01-01

    It is unknown whether high-sensitivity C-reactive protein (hs-CRP) predicts outcome depending on implanted stent type. We investigated the prognostic value of hs-CRP in relation to type of stent implanted in patients with ST-segment elevation myocardial infarction (STEMI). Immediately before...... primary percutaneous coronary intervention (pPCI), 301 patients had blood drawn. Patients were categorized according to hs-CRP levels and combination of hs-CRP (≤2 vs >2 mg/L) and stent type (bare metal stent [BMS] vs drug-eluting stent [DES]). Hs-CRP >2 mg/L (median, hazard ratio 2.7, 95% confidence...

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

    OpenAIRE

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

    2004-01-01

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

  7. 24 hour ST segment analysis in transient left ventricular apical ballooning.

    Directory of Open Access Journals (Sweden)

    Frank Bode

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

  8. Integrated regional network construction for ST-segment elevation myocardial infarction care%区域协同ST段抬高型心肌梗死救治网络建设探讨

    Institute of Scientific and Technical Information of China (English)

    王斌; 王焱; 叶涛; 肖国胜; 常贺; 温红梅; 陈媛; 林吉怡; 杨鹭琳

    2014-01-01

    目的 探讨在我国建立区域协同急性ST段抬高型心肌梗死(STEMI)救治网络系统(IRN-STEMI)的可行性及实施效果.方法 以实时心电图传输技术为纽带,通过管理模式创新,以厦门市心脏中心为核心,协调120急救系统、其他具备直接经皮冠状动脉介入(PCI)能力的医院及部分基层医院等多家医疗单位创建厦门区域协同STEMI救治网络.总结IRN-STEMI运行1年来网络内所有医疗单位STEMI患者的救治情况,对厦门市心脏中心IRN-STEMI建立前(2012年3月16日至2013年3月15日,n=165)和建立后(2013年3月16日至2014年3月15日,n=256)两组患者基线特征,年平均首次医疗接触至球囊(FMC-to-B)时间、平均门至球囊时间(D-to-B)、平均住院天数、住院费用及住院期间病死率进行比较.结果 IRN-STEMI成立前网络内所有医疗单位收治STEMI患者245例,有221例(90.2%)接受再灌注治疗,其中直接PCI 185例(75.5%).IRN-STEMI成立后纳入STEMI患者343例,共321例(93.6%)接受再灌注治疗,其中直接PCI有290例(84.5%).与IRN-STEMI成立前比较,成立厦门市心脏中心后接受直接PCI的STEMI患者年平均FMC-to-B时间[(110.3±34.0)min比(137.9 ±58.5)min,P<0.01]及年平均D-to-B时间[(76.5±33.0)min比(107.3±38.0)min,P<0.01]较短,平均住院天数[(9.0±4.3)d比(9.7±4.8)d,P>0.05]及住院期间病死率[3.1%(8/256)比3.0%(5/165),P>0.05]差异无统计学意义,但平均住院费用明显减少[(51 398 ±22 100)元比(56 970 ±24593)元,P<0.05].结论 在国内由具有数家PCI能力的医院、120急救系统及基层网络医院共同建立区域性STEMI救治网络是可行的.通过IRN-STEMI可显著增加本地区接受直接PCI患者比例,明显缩短FMC-to-B及D-to-B时间,减少住院费用,是提升区域内STEMI救治水平的有效方法.%Objective To investigate the feasibility of establishing an integrated regional network for ST-segment elevation myocardial infarction

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

    OpenAIRE

    Miha Amon; Franc Jager

    2016-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    C.S. Thejanandan Reddy

    2013-07-01

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

  12. 肾功能不全对急性心肌梗死患者长期预后影响的性别差异%Gender difference in the prognostic value of renal dysfunction in patients with ST-segment elevation myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    李超; 胡大一; 李莉; 杨进刚; 宋莉; 马长生

    2015-01-01

    Objective To evaluate the gender difference in the prognostic value of admission renal dysfunction (RD) for patients with acute ST-segment elevation (STEMI).Methods This was a multicenter,prospective cohort study.Four hundred and fifty STEMI patients within 24 h of onset and discharged successfully from 19 hospitals in Beijing were included in the study.All the patients were followed up six years later.According to gender,patients were categorized into two groups.Clinical characteristics,reperfusion therapy conditions and outcomes were analyzed.Multivariate Cox regression analysis was used to evaluate the possible gender difference in the prognostic value of RD.Results Among all the subjects,342 were men and 108 were women with age of (61.3 ± 12.5) years.Compared to man patients,women were older (P < 0.001),and more subjects were with hypertension (67.6% vs 49.7 %,P =0.005),stroke (15.7% vs 8.8%,P =0.039) and RD (17.9% vs 6.7%,P =0.001).After adjustment of age,past medical history,and acute reperfusion therapy.Cox regression analysis showed that RD was associated with the risk of all-cause mortality (HR 3.771,95% CI 1.382-10.294,P =0.010) and major adverse cardiovascular events (MACE,HR 2.292,95% CI:1.091-4.817,P =0.029) in male patients.However,the associations between RD and all-cause mortality(HR 0.889,95% CI 0.241-3.281,P =0.859),and MACE(HR 1.508,95% CI 0.616-3.693,P =0.368)were disappeared in women.The interaction test showed that there existed significant interactions between gender and RD in all-cause mortality(HR 2.709,95%CI 1.150-6.384,P =0.023)and MACE(HR 1.977,95% CI 1.009-3.876,P =0.023).Conclusions There is a considerable gender difference in the prognostic value of RD for the outcomes in patients with STEMI.RD seemed to be an important prognostic maker in male patients.%目的 评价入院时肾功能不全(renal dysfunction,RD)对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者长

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

    OpenAIRE

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

    2013-01-01

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

  14. A randomized, double-blind, placebo-controlled trial to evaluate the safety and effectiveness of intracoronary application of a novel bioabsorbable cardiac matrix for the prevention of ventricular remodeling after large ST-segment elevation myocardial infarction: Rationale and design of the PRESERVATION I trial.

    Science.gov (United States)

    Rao, Sunil V; Zeymer, Uwe; Douglas, Pamela S; Al-Khalidi, Hussein; Liu, Jingyu; Gibson, C Michael; Harrison, Robert W; Joseph, Diane S; Heyrman, Reinilde; Krucoff, Mitchell W

    2015-11-01

    Postinfarction left ventricular (LV) remodeling can result in chronic heart failure and functional impairment. Although pharmacological strategies for established heart failure can be beneficial, preventing remodeling remains a challenge. Injectable bioabsorbable alginate or "bioabsorbable cardiac matrix" (BCM), composed of an aqueous mixture of sodium alginate and calcium gluconate, is a sterile colorless liquid that is a polysaccharide polymer produced from brown seaweed. When exposed to excess ionized calcium present in infarcted myocardium, BCM assembles to form a flexible gel, structurally resembling extracellular matrix, which provides temporary structural support to the infarct zone through and beyond the time needed for mature fibrotic tissue to develop. The PRESERVATION I trial is an early phase randomized, double-blind, placebo-controlled trial comparing intracoronary application of 4 mL of BCM with saline control in patients who develop large infarctions after successful reperfusion of large ST-segment elevation myocardial infarction (MI). Subjects will be randomized 2:1 to either BCM or saline control and will have the study device deployed through an intracoronary microcatheter in the infarct-related artery 2 to 5 days after index ST-segment elevation MI treated with successful primary or rescue percutaneous coronary intervention. The primary effectiveness end point is the absolute change in LV diastolic volume index as measured by 3-dimensional echocardiography from baseline to 6 months after BCM deployment. Secondary effectiveness end points include clinical outcomes, patient-reported quality of life, additional echocardiographic measures, and functional status measures. In summary, the PRESERVATION I trial is a randomized double-blind trial evaluating the effectiveness and safety of the novel device BCM in preventing LV remodeling patients who have large MIs despite undergoing successful primary or rescue percutaneous coronary intervention.

  15. 慢性阻塞性肺疾病低氧血症对ST段抬高型心肌梗死行经皮冠状动脉介入治疗预后的影响%Impact of chronic obstructive pulmonary disease hypoxemia on the prognosis of ST-segment elevation myocardial infarction treated with percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    袁莉; 贾邵斌

    2016-01-01

    Objectiv e:To explore the impact of chronic obstructive pulmonary disease(COPD) hypoxemia on the prognosis of ST-segment ele-vation myocardial infarction ( STEMI) treated with percutaneous coronary intervention ( PCI) .Methods:200 cases of STEMI patients undergoing PCI complicated with COPD were collected and divided into group A (110 cases) with hypoxemia and group B (90 cases) without hypoxemia.Left ventricular end-diastolic diameter ( LVED) , left ventricular ejection fractions ( LVEF) , length of hospital stay, cardiogenic shock, acute renal failure, death and Thrombolysis in myocardial infarction ( TIMI) of patients were observed.Results:The length of hospital stay and LVED in the group A were higher than those in the group B , and LVEF in the group A was lower than that in the group B .The differences were statistically sig-nificant ( P <0.05); The rates of cardiogenic shock, acute renal failure, TIMI bleeding in the group A were higher than those in the group B ( P <0.05).Conclusion:COPD hypoxemia affects the clinical effect of STEMI treated with PCI, which increases the possibility of disease recur-rence.%目的:探讨慢性阻塞性肺疾病( chronic obstructive pulmonary disease ,COPD)低氧血症对ST段抬高型心肌梗死( ST elevation myocardial infarction ,STEMI)行经皮冠状动脉介入治疗( percutaneous coronary intervention ,PCI)预后的影响。方法:收集200例行经PCI的STEMI且并发COPD患者,根据患者是否患低氧血症分为A组(110例)和B组(90例),观察患者左心室舒张末期内径(left ventricular end diastolic,LVED),左室射血分数(left ventricular ejection fractions,LVEF)、住院时间、发生心源性休克、急性肾衰竭、死亡及血流分级( Thrombolysis in myocardial infarction ,TIMI)。结果:A组住院时间、LVED高于B组,LVEF低于B组( P <0.05),A组心源性休克、急性肾衰竭、TIMI出血例数高于对照组( P <0

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

    Science.gov (United States)

    Amon, Miha; Jager, Franc

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Miha Amon

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

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

    Science.gov (United States)

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

    2016-01-01

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

  19. Acute Myocardial Infarction in a 26-Year-Old Patient With Familial Hypercholesteremia

    OpenAIRE

    Miyayama, Takeshi; Miura, Shin-ichiro; Komaki, Tomo; Kuwano, Takashi; Morii, Joji; Nishikawa, Hiroaki; Saku, Keijiro

    2016-01-01

    A 26-year-old male suffered sustained chest pain. Electrocardiogram showed ST-segment elevation in the anteroseptal wall and reciprocal ST-segment change in the inferior wall. The troponin-I level and the white blood cell count were elevated. We gave a diagnosis of acute myocardial infarction. He underwent urgent coronary angiography, which revealed 90% diffuse stenosis in the middle right coronary artery and total occlusion in the proximal left anterior descending coronary artery (LAD). Sinc...

  20. Acute Myocardial Infarction. An Update of the Clinical Practice Guideline

    OpenAIRE

    Yanier Coll Muñoz; Francisco de Jesús Valladares Carvajal; Claudio González Rodríguez

    2016-01-01

    Clinical practice guidelines present all relevant evidence on a particular issue in order to help physicians select the best treatment strategies. This guideline aims to optimize the diagnostic process and treatment of acute myocardial infarction, to assess adherence to issued guidelines and to propose changes based on the results obtained. It refers to patients with ischemic symptoms or their equivalents, persistent ST-segment elevation or ST-segment and T-wave changes consistent with the di...

  1. Early routine post-thrombolysis percutaneous coronary intervention vs.primary PCI in ST-segment elevated myocardial infarction: a comparative study%急性ST段抬高心肌梗死溶栓后早期介入治疗与直接介入治疗的对比研究

    Institute of Scientific and Technical Information of China (English)

    万方; 张拓; 沈玲红; 卜军; 宋玮; 杜勇平; 金叔宣; 沈节艳; 何奔

    2013-01-01

    目的 评估急性ST段抬高心肌梗死(STEMI)溶栓后早期经皮冠状动脉介入治疗(PCI)与直接PCI有效性及安全性的差异.方法 纳入2010年1月至2011年12月期间在我中心行早期PCI及直接PCI治疗的急性STEMI患者,比较两组住院期间临床终点事件的发生率.采用多因素回归以及倾向积分法计算再灌注策略对临床终点事件的校正相对危险度(RR).结果 早期PCI组共纳入51例患者,直接PCI组共纳入159例患者.两组主要心血管不良事件发生率分别为:早期PCI组4.0%和直接PCI组5.7% (RR =0.647,95% CI:0.155 ~3.103).多因素回归校正RR为0.663(95% CI:0.131 ~3.351),倾向积分法校正RR为0.316(95% CI:0.026 ~3.879).安全性终点方面,两组TIMI出血发生率分别为早期PCI组4.0%和直接PCI组1.9%(RR=2.078,95% CI:0.357~12.095).多因素回归校正RR为2.122(95% CI:0.345~ 13.070),倾向积分法校正RR为0.302(95% CI:0.010 ~9.228).所有结果均未显示差异具有统计学意义.结论 对于直接PCI可能延迟的STEMI患者,溶栓后早期PCI治疗是一种有效、安全的替代再灌注策略.%Objective Compare the efficacy and safety of early routine post-thrombolysis percutaneous coronary intervention (early PCI) with primary percutaneous coronary interventionin(PPCI) for acute ST-segment elevated myocardial infarction ( STEMI). Methods From January 2010 to December 2011 , patients receiving early PCI or primary PCI in our center were screened and enrolled into this study. Incidences of in-hospital clinical events of two groups were compared. The risk ratios of efficacy and safety endpoints were adjusted by multivariable logistic regression and propensity score. Results 51 patients in early PCI group and 159 in PPCI group were finally included. The major cardio-cerebro vascular adverse event rates were 4. 0% in early PCI group and 5. 7% in PPCI Group (RR =0. 647,95% confidence interval 95% CI:0. 155 -3. 103). For safety

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

    DEFF Research Database (Denmark)

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

    2016-01-01

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

  3. A "simplified" culotte technique using two dedicated bifurcation stents and additional angiographic stent enhancement to treat a complex bifurcation lesion in non-ST segment elevation myocardial infarction with poor left ventricular function

    NARCIS (Netherlands)

    Chan, Yu Ho; Stella, Pieter R.; Agostoni, Pierfrancesco

    2015-01-01

    We present a case of a bifurcation lesion treated with two dedicated sirolimus eluting bifurcation stents, BiOSS Lim in the setting of non-ST elevation myocardial infarction and poor left ventricular function. We demonstrate the feasibility of a new technique, a "simplified" culotte technique. The k

  4. Transient ST-segment-elevation during transcatheter closure of atrial septal defect(ASD) with ASD occluder made in China: A report of two cases%国产封堵器闭合房间隔缺损过程中的短暂ST段抬高2例

    Institute of Scientific and Technical Information of China (English)

    王显; 胡大一; 孙琪; 谭琛

    2008-01-01

    目的 国产房间隔封堵器闭合房间隔缺损的安全性和有效性已得到证实.我们报告在使用国产封堵器闭合房间隔缺损过程中出现的短暂ST段抬高现象2例.方法 适合进行经皮封堵术的房间隔缺损患者35例,使用北京华医圣杰公司生产的房间隔封堵器进行封堵.术前经胸超声充分评估缺损的大小、位置、与周围结构的距离以及房间隔的软硬边缘等,选择封堵器要与缺损的伸展直径相匹配.手术过程在局部麻醉或者基础麻醉下进行,术中使用经胸超声引导.封堵器释放后有效闭合缺损、位置稳定且不影响周边结构视为手术成功.术后3,6,12月进行随访.结果 在35例患者中有2例在封堵器释放过程中,出现短暂性ST段抬高超过2 mV,伴有心绞痛发作.心电图改变和症状发作平均持续时间(4.2±2.2)min,2例心电图改变均发生于Ⅱ,Ⅲ和aVF导联,此过程伴有心率减慢和血压降低.静脉注射硝酸甘油后心电图和症状没有得到即刻改善,但封堵器沿鞘管被收回后心电图立即改善、症状逐渐消失.换用较小型号的封堵器闭合房间隔缺损后,没有引起任何血流动力学异常和短暂性心电图改变.随访3,6,12月没有发现心肌缺血和心绞痛发作.结论 经导管闭合房间隔缺损过程中出现的短暂ST段抬高现象,可能与所选封堵器直径过大,刺激房间隔有关.%AIM The safety and efficacy of atrial septal defect (ASD) occluder(ASDO) made in China for transeatheter closure of ASD have investigated prospectively. We report the phenomenon of transient ST-segment-elevation(TSTE) during transcatheter closure of ASD with ASDO made in China in this single-centre study. METHODS A total of 35 consecutive patients in whom a septal defect occluder (Huayishengjie Inc. , Beijing, China) was used to close a clinically significant ASD were included in our study. All procedures performed under basic or local anaesthesia

  5. Advances in Pharmaco-Invasive Therapy combined with Reperfusion in the Treatment of ST-Segment Elevation Myocardial Infarction%ST段抬高性心肌梗死药物-介入联合再灌注治疗的研究进展

    Institute of Scientific and Technical Information of China (English)

    汪雁博; 王学超; 傅向华

    2011-01-01

    Both thrombolysis and percutaneous coronary intervention ( PCI ) are important reperfusion strategies in the treatment of ST - segment elevation myocardial infarction ( STEMI ). However, there are many limitations for the use of these methods. As a result, it may be necessary to evaluate an advanced pharmaco - invasive therapy which combined medical treatment with PCI. This article has reviewed the research advances in the pharmaco - invasive therapy of STEMI.%溶栓和经皮冠状动脉介入治疗(PCI)是目前ST段抬高性心肌梗死(STEMI)治疗中主要的再灌注策略.但是两种治疗方法均存在明显局限性,因此探讨优化的药物-介入联合再灌注治疗策略十分必要.本研究就药物-介入联合再灌注治疗策略在STEMI治疗中的研究进展进行综述,为临床治疗提供参考.

  6. ST-segment deviation during 24-hour ambulatory electrocardiographic monitoring and exercise stress test in healthy male subjects 51 to 75 years of age: the Copenhagen City Heart Study

    DEFF Research Database (Denmark)

    Vaage-Nilsen, M; Rasmussen, Verner; Sørum, C;

    1999-01-01

    BACKGROUND: Although ST-segment deviation has been evaluated and used during many years both on continuous electrocardiographic Holter monitoring and during exercise stress testing, considerable controversy still remains concerning the prevalence and diagnostic significance of fortuitously...... discovered ST-segment deviation in asymptomatic healthy persons. METHODS AND RESULTS: The occurrence of ST-segment deviation was studied in a population of 63 clinically healthy male subjects 51 to 75 years of age, with the use of 24-hour Holter monitoring and exercise stress testing. The subjects were...... in healthy subjects without disease, was 1.0 when using as criterion for significant ST-segment deviation a horizontal or descending ST-segment depression of >0.20 mV or ST-segment elevation >/=0.15 mV during Holter monitoring, and acceptable, for example, 0.95, when using as criterion a horizontal...

  7. Inflammation: a trigger for acute coronary syndrome.

    Science.gov (United States)

    Sager, Hendrik B; Nahrendorf, Matthias

    2016-09-01

    Atherosclerosis is a chronic inflammatory disease of the vessel wall and a major cause of death worldwide. One of atherosclerosis' most dreadful complications are acute coronary syndromes that comprise ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction, and unstable angina. We now understand that inflammation substantially contributes to the initiation, progression, and destabilization of atherosclerosis. In this review, we will focus on the role of inflammatory leukocytes, which are the cellular protagonists of vascular inflammation, in triggering disease progression and, ultimately, the destabilization that causes acute coronary syndromes. PMID:27273431

  8. Peri-procedural levels of multiple serum biomarkers and prognosis in ST-segment elevation myocardial infarction patients undergoing primary angioplasty%急性心肌梗死患者直接经皮冠状动脉介入治疗围手术期多血清标志物与预后

    Institute of Scientific and Technical Information of China (English)

    赵博; 颜红兵; 赵汉军; 宋莉; 周鹏; 刘臣

    2012-01-01

    predicting the outcome of patients. This study is to evaluate the role of peri-procedural multiple serum biomarkers approach in the assessment of the prognosis in acute ST-segment elevation myocardial infarction (STEMI) patients undergoing primary angioplasty. Methods This study is a sub-study of the SUIT-AMI trial (Impacts of superselective IRA infusion of glucoprotein Ⅱ b/Ⅲa inhibitor on myocardial reperfusion and bleeding complications in AMI patients, NCT01181388) including 203 consecutive patients with STEMI who underwent primary angioplasty. The complete data of biomarkers was available for analysis in 145 of 203 patients. According to the pre-procedure cardiac troponin Ⅰ (20 ng/ml) and high sensitive CRP ( 10 mg/ L) and instantly post-procedure N-terminal probrain natriuretic peptide (2000 fmol/ml) , these patients were divided into four groups (low value, n =50; single high value, n =62; double high values, n =26; and triple high values, n =7). In-hospital ultrasound based cardiac function,30-day and 180-day major adverse cardiac events [MACE, including cardiac death, recurrent myocardial infarction (MI) and target vascular revascularization (TVR)] and bleeding were recorded for analysis. Results In-hospital MACE were recorded in four patients. Of them, three in the low value group (6% ) and one in the triple high values group (14% ) with a tendency of higher than other three groups (χ2 =7.922, P = 0. 048). At 30-day follow-up, there were 7 MACEs including two deaths (all from double high values group) , three recurrent Mis and two TVRs without significant differences between groups (χ2 = 5. 381 , P > 0. 05 ) . However, the 30 day mortality of the double high value group was greatly higher than other groups (8% us. 0% ,χ2 = 9. 282, P = 0. 026). At 180-day follow-up, there were 10 MACEs including five deaths, three recurrent Mis and two TVRs without great difference between groups. Conclusions Abnormal multiple serum biomarkers may indicates a poor prognosis

  9. 不同性别ST段抬高心肌梗死患者急诊冠状动脉介入治疗临床特征分析%Comparison of clinical features following ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention in patients with different gender

    Institute of Scientific and Technical Information of China (English)

    徐鲲; 彭瑜; 王金涛; 赵存瑞; 王邁; 张钲

    2014-01-01

    Objective To investigate the presence of gender differences in clinical characteristics in patients presenting with first acute ST-segment elevation myocardial infarction(STEMI),treated with primary percutaneous coronary intervention (PCI).Methods A total of 21 1 patients(1 6.59% women)presenting with STEMI who underwent primary PCI within 1 2 hours following onset of ischemic symptoms were selected. Those patients were divided into male group (n =1 76 ) and female group (n =35 ). Clinical data, angiography findings,PCI procure data and echocardiographic evaluation were compared between genders. Results Compared with male group,female had older mean age[(67 ±8)years vs (60 ±1 1 )years,P=0.001 ],more co-morbidities and longer symptom duration [(428 ±228 )min vs (331 ±232 )min,P=0.024],whereas,the rate of smoking habit was significantly lower in female than that in male group(P<0.001 ).Female had higher mean platelet volume,total cholesterol,LDL-C than male,whereas,male had higher creatinine and hemoglobin than female.There were no difference in hospital care,length of hospital stay and in-hospital mortality between each group.A logistic multivariate analysis model revealed that female (OR=2.50,95%CI 1 .06-5.89,P=0.036),anterior myocardial infarction(OR=6.35,95%CI:3.44-1 1 .71 ,P<0.001 )were positively associated with left ventricular ejection fractions<50%.Conclusions Female following first STEMI are older,more co-morbidities and longer symptom duration.Despite receiving similar treatment as male patients,female patients demonstrate a worse systolic left ventricular function.%目的探讨急性ST段抬高心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)中不同性别患者临床特点及预后的差异。方法采用回顾性分析,选择211例首次发作STEMI经急诊PCI患者,收集临床、造影、介入及心脏超声资料。以性别分组比较基本临床资料、入院检查及治疗情况、早期心功能之间的差

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

    Science.gov (United States)

    Kou, Victoria; Nassisi, Denise

    2006-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    刘长纲

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Surendra Dalu

    2012-06-01

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

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

    OpenAIRE

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

    2005-01-01

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

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

    OpenAIRE

    Surendra Dalu; Nilesh Pawar

    2012-01-01

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

  15. Effect of tirofiban in acute anterior myocardial infarction patients without ST segment resolution after primary percutaneous coronary intervention%替罗非班对急诊冠状动脉介入治疗后ST段回落不良的急性前壁心肌梗死患者预后的影响

    Institute of Scientific and Technical Information of China (English)

    彭建军; 马志敏; 任利辉; 付桂琴; 贾凯英; 雷力成; 叶慧明

    2009-01-01

    Objective To observe the effect of glycoprotein receptor blockade tirofiban in acute anterior myocardial infarction patients without ST segment resolution after primary percutaneous coronary intervention (PCI). Methods From April 2006 to April 2008, 157 acute anterior myocardial infarction patients without ST segment resolution after PCI were randomly allocated to tirofiban (intravenous bolus 10 fig/kg followed by intravenous infusion of 0. 15 μg·kg-1·min-1 for 48 h, n =80) or equal volume saline (control group, n =77). Baseline characteristics, PCI features and clinical outcomes during hospitalization, left ventricular ejection fractions (LVEF) and major adverse cardiac events (MACE, including death, re-infarction and target vessel revascularization) at 30 and 180 days after discharge were compared between the two groups. Results The baseline clinical characteristics were comparable between the two groups. Compared to control group, the MACE rates and re-infarction rates at 30 days (6. 3% vs. 18. 2% , P < 0.05; 1.3% vs. 9. 1%, P<0.05, respectively) and 180 days (10.0% vs. 23. 4% , P<0.05; 2.5% vs. 10.4% , P < 0. 05, respectively ) were significantly reduced in tirofiban group. LVEF value was significantly higher in tirofiban group at 30 days and 180 days compared with those in control group [ (51 ± 6)% vs. (46±8)%, P<0.05; (57±7)% vs. (50±9)%, P<0.05]. Hemorrhagic complications were similar between the two groups. Conclusion Use of tirofiban for acute anterior myocardial infarction patients without ST segment resolution after PCI is safe and can significantly improve 30 and 180 days clinical outcomes after discharge.%目的 探讨血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂替罗非班对直接经皮冠状动脉介入治疗后出现ST段回落不良的急性前壁心肌梗死患者预后的影响.方法 2006年4月至2008年4月共入选157例急性前壁心肌梗死患者,随机将患者分为两组.治疗组(80例)在术后1 h应用替罗非班(10

  16. 慢性肾功能衰竭血尿酸水平与急性 ST 段抬高心肌梗死患者预后关系研究%Serum uric acid level in chronic renal failure and its relationship with prognosis of ST-segment elevation myocardial in-farction

    Institute of Scientific and Technical Information of China (English)

    董丽娜

    2014-01-01

    Objective To study the relationship between serum uric acid level in chronic renal failure (CRF) and the prognosis of ST-segment elevation myocardial infarction(STEMI) .Methods The patients with CRF compli-cating hyperuricemia were selected as the observation group ,the patients with CRF and without comlicating hyperuri-cemia as the negative control group and the patients with normal renal function and hyperuricemia as the positive con-trol group .The cases of STEMI occurrence were observed .The cardiac function related indexes were detected and the negative emotions were evaluated .The related factors of STEMI occurrence were performed the Logistic regression a-nalysis .Results Hyperuricemia existed in different stages of CRF ,its expression level was significantly higher than that in the normal renal function group ;the occurrence of STEMI had the positive relationship with hyperuricemia ,a-nemia ,malnutrition ,hypertension ,ectopic calcification and depression ;LVEDD and LVEF in the observation group were significantly lower than those in the control group ,while the cases of myocardial infarction occurrence ,ST seg-ment elevation degrees and the scores of HAMD ,HAMA and VAS were significantly higher than those in the control group .Conclusion Hyperuricemia is a risk factor of myocardial infarction induced by CRF ,and can cause the damage of cardiac function to different degrees .%目的:研究慢性肾衰竭血尿酸水平与急性ST段抬高心肌梗死患者预后的关系。方法选择慢性肾衰竭合并高尿酸血症患者作为观察组、慢性肾衰竭未合并高尿酸血症患者作为阴性对照组、肾功能正常的高尿酸血症患者作为阳性对照组,观察发生心肌梗死的例数、检测心功能相关指标、评估负面情绪,并对心肌梗死发生的相关因素进行logistic回归分析。结果慢性肾衰竭不同分期均存在高尿酸血症,其表达水平明显高于肾功能正常组;心肌梗死的发生

  17. Visual functional changes during acute elevation of intraocular pressure

    Institute of Scientific and Technical Information of China (English)

    Tian-De SHOU

    2006-01-01

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

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

    DEFF Research Database (Denmark)

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

    2012-01-01

    The aim of this study was to evaluate the independent prognostic value of qualitative and quantitative admission electrocardiographic (ECG) analysis regarding long-term outcomes after non-ST-segment elevation acute coronary syndromes (NSTE-ACS). From the Fragmin and Fast Revascularization During...... Instability in Coronary Artery Disease (FRISC II), Invasive Versus Conservative Treatment in Unstable Coronary Syndromes (ICTUS), and Randomized Intervention Trial of Unstable Angina 3 (RITA-3) patient-pooled database, 5,420 patients with NSTE-ACS with qualitative ECG data, of whom 2,901 had quantitative data...

  19. 肝素与低分子肝素治疗ST段抬高性心肌梗死有效性和安全性的Meta分析%Meta-analysis of Effectiveness and Safety of Heparin and Low Molecular Heparin for ST-segment Elevation Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    李小华; 孙毅毅

    2011-01-01

    OBJECTIVE: To evaluate the effectiveness and safety of heparin and low molecular heparin for ST-segment elevation myocardial infarction (STEMI) with evidence-based medicine. METHODS: Clinical controlled trials were retrieved from Cochrane Library, Medline, EMBase, CNKI, CBMdisc. We also searched 8 kinds of Chinese journals by hand, such as Chinese Journal of Cardiology. Randomized controlled trials (RCT) on heparin in the treatment of STEMI were included and analyzed by RevMan 5.0. RESULTS: 8 RCTs involoving 28 179 were included, there was no statistical significance in mortality between low molecular heparin and normal heparin [RR=0.92, 95%CI(0.84, 1.01),P=0.09]. The mortality/nonfatal recurrent MI [RR= 0.81, 95%CI (0.76, 0.88) ,P<0.000 01], recurrent MI [RR=0.66, 95%CI(0.59, 0.74) ,P<0.000 01] of low molecular weight heparin group were lower than normal heparin group. The recirculation [RR=0.84, 95%CI(0.73, 0.97) ,P=0.02] and bleeding rate [RR=1.42,95 % CI (1.21, 1.68), P<0.000 1] of low molecular weight heparin group were higher than normal heparin group. There was statistical significances. CONCLUSION: In effectiveness and safety evaluation of heparin for STEMI, low-molecular weight heparin is prior to normal heparin while the bleeding rate of low-molecular weight heparin group is higher than normal heparin group. Low-molecular weight heparin is suitable for STEMI patients but we should pay attention to the occurrence of severe bleeding.%目的:采用循证医学的方法对肝素治疗ST段抬高性心肌梗死(STEMI)的有效性和安全性进行系统评价.方法:系统检索Cochrane图书馆、Medline、EMBase、CNKI、CBMdisc数据库,手工检索等8种杂志,纳入有关肝素治疗STEMI的随机对照试验(RCT),并采用RevMan 5.0软件进行数据分析.结果:最终纳入8个RCT,28 179例患者.低分子肝素组与普通肝素组比较,病死率[RR=0.92,95%CI(0.84,1.01),P=0.09]无统计学意义,但病死

  20. Correlation and Clinical Significance of Serum Bilirubin Level and TIMI Risk Score in Patients with Non-ST Segment Elevation Myocardial Infarction%非ST段抬高型心肌梗死患者血清胆红素水平与TIMI危险评分的相关性及临床意义

    Institute of Scientific and Technical Information of China (English)

    王涛

    2016-01-01

    目的:探讨非 ST段抬高型心肌梗死(NSTEMI)患者血清胆红素(BIL)水平与TIMI评分的相关性及临床意义。方法收集104例 NSTEMI患者一般资料,包括年龄、性别、体质量指数、血压、糖尿病、低密度脂蛋白胆固醇水平以及吸烟等,清晨空腹采血测定血清总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)水平。采用TIMI评分标准对NSTEMI患者进行风险评估,计算NSTEMI组患者TIMI评分并进行危险分层,以评分差异分组,分为低位组、中危组、高危组;分析 NSTEMI患者血清 BIL水平与 TIMI积分的相关性及临床意义。结果高危组患者TBIL、IBIL水平明显低于中危组、低危组(P<0.01);NSTE-MI组TBIL、IBIL水平与其TIMI分值均有负相关关系(r=-0.20,P<0.05;r=-0.228,P<0.05)。结论NSTEMI 患者血清BIL 水平与TIMI 积分呈负相关,TBIL 对NSTEMI 患者早期危险度分层具有预测价值。%Objective To investigate the correlation and clinical significance of serum bilirubin(BIL)lev-el and TIMI score in patients with non-ST segment elevation myocardial infarction(NSTEMI).Methods The clinical data of 104 patients with NSTEMI patients were collected,including age,gender,body mass in-dex,blood pressure,diabetes,low-density lipoprotein cholesterol(LDL-C)levels and smoking,and the morn-ing fasting blood determination of serum total bilirubin(TBIL),direct bilirubin(DBIL)and indirect bilirubin (IBIL).The TIMI risk score was used for risk assessment of patients with NSTEMI.TIMI scores of NSTEMI patients were calculated and their risks were stratified.Based on score differences,the patients were divided into low-risk group,middle-risk group and high-risk group.The correlation of serum bilirubin levels and TIMI risk score was analyzed as well as its clinical significance.Results 1.TIMI risk stratifica-tion showed that the levels of serum total bilirubin(TBIL)and indirect

  1. Clinical features and prognostic analysis on patients with ST-segment elevation myocardial infarction with chronic total occlusion%合并慢性闭塞病变的急性心肌梗死患者临床特点和近期预后分析

    Institute of Scientific and Technical Information of China (English)

    许敏; 郭金成; 张海滨

    2015-01-01

    目的:分析合并非梗死冠状动脉慢性闭塞( chronic total occlusion,CTO)的急性ST段抬高心肌梗死( ST-segment elevation myocardial infarction,STEMI)的临床特点,探讨CTO病变对STEMI近期预后的影响。方法回顾性分析2011年1月至2012年12月首都医科大学附属潞河医院心脏监护病房(cardiac care unit,CCU)连续收治的STEMI并行急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的391例患者,根据是否存在CTO病变,分为2组:CTO组(n=41例),非CTO组(n=350例)。主要观察指标为分析合并CTO的STEMI 的临床特点、术后30 d主要不良心脏事件( major adverse cardiac event,MACE)发生率和影响MACE的相关因素。结果 CTO组年龄、心功能不全、肾功能不全、三支病变、休克、恶性心律失常和主动脉球囊反搏( intra-aortic balloon pupm,IABP)使用率方面均明显高于非CTO组(P<0.05),CTO组在术后心肌梗死溶栓(thrombolysis in myocardial infarction, TIMI)3级血流明显低于非CTO组(P<0.05)。 CTO组的肌酸磷酸激酶同工酶(creatine kinase MB,CK-MB)峰值和左室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)均明显高于非CTO组〔(307.19±149.04)U/L vs (208.08±129.56)U/L;(55.48±5.58)mm vs (52.33±4.41)mm,P<0.05〕。 CTO组左室射血分数(left ventricular ejection fraction,LVEF)明显低于非CTO组(51.86±9.61 vs 57.76±9.20,P<0.05)。 CTO组术后30 d病死率和MACE发生率明显高于非CTO组(22.0 vs 2.9,22.0 vs 3.7,P<0.05)。多因素Logistic分析预测STEMI患者PCI术后30 d MACE的独立变量依次是:PCI术后TIMI血流<3级、肾功能不全、前壁心肌梗死、年龄≥65岁、恶性心律失常、CTO。结论合并CTO的STEMI患者病情危重,易合并心、肾功能不全、休克

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

    Science.gov (United States)

    Alfirevic, Andrej; Mossad, Emad; Niezgoda, Julie

    2005-01-01

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

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

    NARCIS (Netherlands)

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

    2007-01-01

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

  4. Soluble Urokinase Plasminogen Activator Receptor for Risk Prediction in Patients Admitted with Acute Chest Pain

    DEFF Research Database (Denmark)

    Lyngbæk, Stig; Andersson, Charlotte; Marott, Jacob L;

    2013-01-01

    Plasma concentrations of soluble urokinase plasminogen activator receptor (suPAR) predict mortality in several clinical settings, but the long-term prognostic importance of suPAR in chest pain patients admitted on suspicion of non-ST-segment elevation acute coronary syndrome (NSTEACS) is uncertain....

  5. Clinical risk factors, angiographic findings and prognosis in young adults with ST-segment elevation myocardial infarction%青年ST段抬高型心肌梗死患者的临床、冠状动脉造影特点及预后

    Institute of Scientific and Technical Information of China (English)

    姚康; 张书宁; 葛雷; 钱菊英; 葛均波

    2012-01-01

    Objective To evaluate the clinical characteristics, risk factors, angiographic features, and in-hospital and long-term outcomes in young patients (≤40 years) with ST-segment elevation myocardial infarction (STEMI). Methods From May 2005 to May 2010, the patients with STEMI underwent primary percutaneous coronary intervention (PCI) in our hospital and were enrolled in this retrospective study. These patients were divided into young adult group (40 years or below), middle age group (41-59 years) and elderly group (≥60 years). Clinical cardiovascular risk factors, angiographic findings, PCI outcomes and prognosis during 12-month follow up were analyzed. Results During the 5-year period, 2.2% of STEMI patients admitted to our hospital for PCI were 40 years or below. 95.0% of these young patients were male. Smoking rate in the young adult group was significantly higher than that in the elderly group (85.0% vs. 64.8% , P0.05). The incidence of severe heart failure in the young adult group was significantly lower than that in the elderly group in hospital and 12 months after PCI. The incidence of major adverse cardiovascular event (MACE) in the young adult group was significantly lower than that in the middle age group and elderly group 12 months after PCI (P<0.05). Conclusion There are significant differences in features of risk factors and coronary artery lesions and prognosis between young adults and the elderly with myocardial infarction. Young adults who under going primary PCI have favorable long-term outcomes, such as recovery of cardiac function and MACE.%目的 探讨年龄≤40岁青年ST段抬高型心肌梗死(STEMI)患者的临床发病、危险因素、冠状动脉病变特点及预后.方法 回顾性分析2005年5月-2010年5月在复旦大学附属中山医院心内科行经皮冠状动脉介入治疗(PCI)的STEMI患者,按年龄段分组:青年组(≤40岁),中年组(≥41岁且≤59岁组),老年组(≥60岁).分析各组的危险因素、冠状动

  6. Impact of mean fasting glucose over the first 72 hours on in-hospital outcomes of patients with ST-segment elevation myocardial infarction%平均空腹血糖对ST段抬高型心肌梗死患者住院预后的影响

    Institute of Scientific and Technical Information of China (English)

    刘品明; 林飞宁; 方昶; 张少玲; 王景峰

    2010-01-01

    Objective To evaluate the impact of mean fasting glucose over the first 72 hours after admission on in-hospital outcomes in patients with ST-segment elevation myocardial infarction ( STEMI ).Methods The data of 357 non-diabetic patients hospitalized with STEMI were collected from the database of Sun Yat-sen Memorial Hospital, affiliated to Sun Yat-sen University between January 2006 and April 2009.The patients were categorized into 3 groups according to mean fasting glucose over the first 72 hours after admission: < 5.6 ( n = 165 ), 5.6 - 7.0 ( n = 122 ) and > 7.0 mmol/L ( n = 70). Clinical characteristics,therapeutic approaches and the incidence of heart failure, malignant arrhythmias, and death during hospitalization were compared among groups. Multivariate logistic regression analysis was performed to determine the association between risk factors and in-hospital outcomes. Receiver-operator characteristic (ROC) curve was generated to assess the power of mean fasting glucose on predicting in-hospital death. Results Age, past history of infarction and early revascularization therapy were similar among groups. Heart rate on admission, white blood cell count, peak CK-MB level, and proportion of extensive anterior infarction were increased in proportion to higher mean fasting glucose levels. Higher mean fasting glucose levels were associated with increased risk of reduced left ventricular ejection fraction, heart failure characterized by higher Killip class, and malignant arrhythmias. After multivariate adjustment, mean fasting glucose remained to be an independent risk factor for increased in-hospital death of patients with STEMI (OR = 1.31, 95% CI: 1.10 - 1. 57;P =0. 003). Mean fasting glucose had the higher area under the ROC curve than admission glucose or fasting glucose after admission based on single measurement (0. 758, 0. 674and 0. 717;P < 0. 001 ). Conclusion Mean fasting glucose during first 72 hours after admission is an independent predictor for in

  7. 慢性肾功能不全对ST段抬高型心肌梗死患者经皮冠状动脉介入治疗预后的影响%Influence of chronic renal dysfunction on prognosis of patients with ST-segment elevated myocardial infarction undergoing primary percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    丁超; 胡晓华; 陈方; 张晓玲; 高阅春; 吴长燕

    2012-01-01

    Objective To evaluate the influence of chronic renal dysfunction on prognosis of patients with ST-segment elevated myocardial infarction( STEMI) undergoing primary percutaneous coronary intervention ( PCI). Methods Data of 743 STEMI patients undergoing primary PCI in Beijing Anzhen hospital were retrospectively collected. Patients were divided into the renal dysfunction group and control group according to estimated glomeruar filtration rate(eGFR) 60 mL·min-1· 1.73 m-2. Clinical characteristics,lesion characteristics and prognostic outcomes were compared between the two groups. Results Compared with control group, patients in renal dysfunction group were elder and less male patients, there were more patients with heart failure, hypertension, diabetus mellilus, previous myocardial infarction history .multiple vascular disease and cardiac inadequacy( Killip's grade≥2)in renal dysfunction group(P <0. 05). Major adverse cardiovascular event(MACE) rate and death rate were higher in renal dysfunction group than control group during the period of hospital stay and after following up for 2 years(P <0. 05). The results of Logistic mullifactor regression analysis showed that,eGFR<60 mL·min-1· 1.73 m-2 ,age≥70 years,Killip's grade≥2,diabetus mellitus,previous myocardial infarction history and multiple vascular disease were independent predictors of 2-year death ( P < 0. 05), and the corrected relative risk of eGFR < 60 mL·min-1· 1.73 m-2 was 1.93(95%CI = 1. 24 -4. 56,P = 0. 01). Conclusion Prognosis of STEMI patient undergoing primary PCI combined with chronic renal dysfunction is bad. Estimated GFR <60 mL·min-1·1.73 m-2 is the strongest risk factor for unfavourable prognosis of the STEMI patients who undergo primary PCI.%目的 评价慢性肾功能不全对ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)预后的影响.方法 回顾性收集因STEMI在北京安贞医院接受急诊PCI的患者743例.将肾小球滤过率(eGFR)<60 m

  8. Curative effects and safety of perradial or transfemoral percutaneous coronary interventions on ST- segment elevation myocardial infarction:a Meta-analysis%经桡动脉与经股动脉途径介入治疗ST段抬高心肌梗死疗效及安全性的Meta分析

    Institute of Scientific and Technical Information of China (English)

    卜国森; 刘志强; 何鹏义; 木胡牙提; 杨玉春; 张雷

    2015-01-01

    Objective To review systematically the curative effects and safety of perradial or transfemoral percutaneous coronary interventions (PCI) on ST-segment elevation myocardial infarction (STEMI).Methods The databases of PubMed (from 1994 to May 2014), EMbase (from 2000 to May 2014), Cochrane Library (No. 4 of 2012 Vol.), CBM (from 2004 to May 2014), CNKI (from 2004 to May 2014) and WanFang Database (from 2004 to May 2014) were retrieved with computer for searching the randomized controlled trials (RCT) about the curative effect and safety of transfemoral PCI on STEMI. All materials were given document screen, data extract and quality review by 2 reviewers according to inclusion and exclusion criteria, and then given a Meta-analysis by using RevMan5.2 software.Results There were finally 13 RCT included involving 5158 cases. The results of Meta-analysis showed that mortality (2.8%vs. 4.8%;OR: 0.56, 95%CI: 0.41~0.77;P curative effect and overall safety are needed to be confirmed with more large-sample and high-quality RCT.%目的:系统评价经桡动脉与经股动脉途径行经皮冠状动脉介入术(PCI)治疗ST段抬高性心肌梗死(STEMI)疗效及安全性,为临床实践提供最佳证据。方法计算机全面检索PubMed(1994~2014.05)、EMbase(2000~2014.05)、Cochrane Library(2012年第4期)、CBM (2004~2014.05)、CNKI(2004~2014.05)、Wanfang data(2004~2014.05),查找经股动脉途径介入治疗STEMI的疗效及安全性的随机对照试验(RCT)。由2名评价员按照纳入和排除标准独立进行文献筛选、资料提取和质量评价后,采用RevMan 5.2软件进行Meta分析。结果最终共纳入13个RCT共5158例。Meta分析结果显示:与经股动脉途径组相比,经桡动脉途径组可以明显减少死亡率(2.8% vs.4.8%;OR:0.56,95%CI:0.41~0.77;P<0.001),主要大出血发生率(1.3%vs.2.9%;OR:0.48,95%CI:0.31~0.72;P<0.001),主要不良

  9. Efficacy and Prognosis of Monitoring Pulse Oxygen Saturation During Primary Percutaneous Coronary Intervention with ST-segment Elevation Myocardial Infarction%急诊PCI中监测血氧饱和度对急性S T段抬高型心肌梗死的疗效和预后的影响

    Institute of Scientific and Technical Information of China (English)

    王红雷; 董平栓; 尚喜燕; 邢适颖; 李治国; 曲红培

    2014-01-01

    Objective To investigate the relationship between pulse oxygen saturation (SpO2 ) during primary percutaneous coronary intervention(PCI)in patients with ST-segment elevation myocardial infarction (STEMI)and its clinical efficacy and prognostic value. Methods We studied 126 STEMI patients who monitored pulse oxygen saturation continuously during primary PCI.According to the SpO2 ,the patients were divided into the observation group(n=58,SpO2 90%), observing the number of the stenotic vessls,left ventricular end-systolic volume (LVESV ),left ventricular end-diastolic volume(LVEDV)and left ventricular ejection fraction (LVEF)4 weeks after PCI,and also analyzing the major adverse cardiac events (MACE ) and six-minute walk test between the hospitalization period and 1 year after PCI. Results There were no significant differences in sex,age,susceptible factors (eg hypertension,hyperlipidemia,diabetes mellitus,smoking,et al),hemoglobin level,original heart disease history,door to balloon time and the number of stent implantation between the two groups in the baseline characteristics.The number of the stenotic vessls in the observation group was more than the observation group [P<0.05],and the percentage of infarct-related artery in the left anterior descending artery was also higher (P<0.05).The diameters of LVESV,LVEDV were larger,and the LVEF was lower than the control group. The incidence of MACE between the hospitalization period and 1 month after PCI in the observation group was higher,while shorter with the six-minute walk test than the control group. Conclusion The SpO2 during primary PCI with STEMI is a reliable index in evaluating the clinical efficacy and prognostic value,which can guide clinical practice.%目的:探讨急诊经皮冠状动脉介入治疗(PCI)术中脉搏血氧饱和度(SpO2)水平与急性 ST段抬高型心肌梗死(STEMI)患者临床疗效和预后的关系。方法选择进行急诊PCI术的STEMI患者126例,依据 SpO2

  10. Clinical efficacy evaluation of Shuangshen Tongguan capsule on acute myocardial infarction patients after direct percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    王永刚

    2013-01-01

    Objective To evaluate the therapeutic efficacy of Shuangshen Tongguan Capsule(STC) on acute myocardial infarction(AMI) patients after direct percutaneous coronary intervention(PCI). Methods Using a randomized controlled method,AMI patients with elevated ST segment after successful direct PCI were randomly assigned

  11. Rapid Endovascular Catheter Core Cooling Combined With Cold Saline as an Adjunct to Percutaneous Coronary Intervention for the Treatment of Acute Myocardial Infarction

    DEFF Research Database (Denmark)

    Erlinge, David; Götberg, Matthias; Lang, Irene;

    2014-01-01

    OBJECTIVES: The aim of this study was to confirm the cardioprotective effects of hypothermia using a combination of cold saline and endovascular cooling. BACKGROUND: Hypothermia has been reported to reduce infarct size (IS) in patients with ST-segment elevation myocardial infarctions. METHODS: In...... incidence of heart failure and a possible effect in patients with early anterior ST-segment elevation myocardial infarctions need confirmation. (Efficacy of Endovascular Catheter Cooling Combined With Cold Saline for the Treatment of Acute Myocardial Infarction [CHILL-MI]; NCT01379261)....

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

    OpenAIRE

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

    2004-01-01

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

  13. Effect of EPO administration on myocardial infarct size in patients with non-STE acute coronary syndromes; results from a pilot study

    NARCIS (Netherlands)

    A. Liem; A.P. van de Woestijne; E. Bruijns; H.W.O. Roeters van Lennep; J.A.J. de Boo; H.K. van Halteren; T.P. van Es; J.W. Jukema; A. van der Laarse; A.H. Zwinderman; D.J. van Veldhuisen

    2009-01-01

    A pilot study was performed to determine the effect of 40,000 IU Epo on myocardial damage in 51 patients with non-ST segment elevation acute coronary syndrome (non-STE ACS). No significant difference in myocardial damage was found, but an increased systolic blood pressure was noticed.

  14. Effect of EPO administration on myocardial infarct size in patients with non-STE acute coronary syndromes; results from a pilot study

    NARCIS (Netherlands)

    Liem, Anho; van de Woestijne, Anton P.; Bruijns, Erik; Roeters van Lennep, Henk W. O.; de Boo, Job A. J.; van Halteren, Henk K.; van Es, Teun P.; Jukema, J. Wouter; van der Laarse, Arnoud; Zwinderman, Aeilko H.; van Veldhuisen, Dirk J.

    2009-01-01

    A pilot study was performed to determine the effect of 40,000 IU Epo on myocardial damage in 51 patients with non-ST segment elevation acute coronary syndrome (non-STE ACS). No significant difference in myocardial damage was found, but an increased systolic blood pressure was noticed. (C) 2007 Elsev

  15. Quality indicators for acute myocardial infarction

    DEFF Research Database (Denmark)

    Schiele, Francois; Gale, Chris P; Bonnefoy, Eric;

    2016-01-01

    infarction (AMI), but no such indicators exist in Europe. In this context, the European Society of Cardiology (ESC) Acute Cardiovascular Care Association (ACCA) has reflected on the measurement of quality of care in the context of AMI (ST segment elevation myocardial infarction (STEMI) and non-ST segment...... be estimated solely on the basis of patients' clinical outcomes. Thus, measuring the process of care through quality indicators (QIs) has become a widely used practice in this context. Other professional societies have published QIs for the evaluation of quality of care in the context of acute myocardial...... elevation myocardial infarction (NSTEMI)) and created a set of QIs, with a view to developing programmes to improve quality of care for the management of AMI across Europe. We present here the list of QIs defined by the ACCA, with explanations of the methodology used, scientific justification and reasons...

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

    OpenAIRE

    You Jia; Jiang Kai; Chen Hang; Wen Haoxiang

    2015-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2013-01-01

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

  18. Troponin elevation in conditions other than acute coronary syndromes

    Directory of Open Access Journals (Sweden)

    Tanindi A

    2011-09-01

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

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

    Science.gov (United States)

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

    2016-08-01

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

  20. Ticagrelor or prasugrel versus clopidogrel in elderly patients with an acute coronary syndrome: Optimization of antiplatelet treatment in patients 70years and older-rationale and design of the POPular AGE study

    NARCIS (Netherlands)

    Qaderdan, K.; Ishak, M.; Heestermans, A.A.; Vrey, E. de; Jukema, J.W.; Voskuil, M.; Boer, M.J. de; Hof, A.W.J.; Groenemeijer, B.E.; Vos, G.J.; Janssen, P.W.; Bergmeijer, T.O.; Kelder, J.C.; Deneer, V.H.; Berg, J.M. van den

    2015-01-01

    RATIONALE: Dual antiplatelet therapy with acetylsalicylic acid in combination with a more potent P2Y12- inhibitor (ticagrelor or prasugrel) is recommended in patients with acute coronary syndrome without ST-segment elevation (NSTE-ACS) to prevent atherothrombotic complications. The evidence on which

  1. Ticagrelor or prasugrel versus clopidogrel in elderly patients with an acute coronary syndrome : Optimization of antiplatelet treatment in patients 70years and older-rationale and design of the POPular AGE study

    NARCIS (Netherlands)

    Qaderdan, Khalid; Ishak, Maycel; Heestermans, Antonius A C M; de Vrey, Evelyn; Jukema, J Wouter; Voskuil, Michiel; de Boer, Menko-Jan; Van't Hof, Arnoud W J; Groenemeijer, Björn E; Vos, Gerrit-Jan A; Janssen, Paul W A; Bergmeijer, Thomas O; Kelder, Johannes C; Deneer, Vera H M; Ten Berg, Jurriën M

    2015-01-01

    RATIONALE: Dual antiplatelet therapy with acetylsalicylic acid in combination with a more potent P2Y12- inhibitor (ticagrelor or prasugrel) is recommended in patients with acute coronary syndrome without ST-segment elevation (NSTE-ACS) to prevent atherothrombotic complications. The evidence on which

  2. A comparison between upfront high-dose tirofiban versus provisional use in the real-world of non-selected STEMI patients undergoing primary PCI Insights from the Zwolle acute myocardial infarction registry

    NARCIS (Netherlands)

    Heestermans, A. A. C. M.; Hermanides, R. S.; Gosselink, A. T. M.; de Boer, M. J.; Hoorntje, J. C. A.; Suryapranata, H.; Ottervanger, J. P.; Kolkman, E.; ten Berg, J. M.; Zijlstra, F.; van 't Hof, A. W. J.; Dambrink, Jan Hendrik Everwijn

    2010-01-01

    Background. Despite the proven benefit of glycoprotein IIb/IIIa blockers in patients with acute ST-segment elevation myocardial infarction (STEMI), there is still debate on the timing of administration of these drugs and whether all or only a selection of patients should be treated. We evaluated the

  3. Effect of Administrative HDL-C Level on Adverse Cardiovascular Events After Discharge in Elder Patients With ST-segment Elevation Myocardial Infarction%老年ST段抬高型心肌梗死患者入院时高密度脂蛋白胆固醇水平对出院后不良心血管事件的影响研究

    Institute of Scientific and Technical Information of China (English)

    刘永; 葛华; 房玲

    2014-01-01

    Objective: To investigate the effect of administrative HDL-C (high density lipoprotein cholesterol) level on adverse cardiovascular events after discharge in elder patients with ST-segment elevation myocardial infarction (STEMI). Methods: A total of 325 STEMI patients treated in our hospital from 2010-04 to 2012-07 were retrospectively studied. According to administrative HDL-C level, the patients were divided into 2 groups as High HDL-C group, n=139 and Low HDL-C group, n=186. The basic and clinical conditions, in-hospital treatment, death and the medication, adverse cardiovascular events during 6 and 12 months follow-up period were compared between 2 groups. Results: The patients with in-hospital reperfusion therapy was higher in Low HDL-C group, and Low HDL-C group had the higher ratio of emergent PCI treatment, all P Conclusion: The lower administrative HDL-C level in elder patients with STEMI had the higher risk of adverse cardiovascular events after discharge.%目的:探讨分析老年ST段抬高型心肌梗死(STEMI)患者入院时高密度脂蛋白胆固醇(HDL-C)水平对出院后心血管不良事件发生情况的影响。  方法:选取我院于2010-04至2012-07收治的325例老年STEMI患者,根据患者的HDL-C水平将其分为HDL-C高组(139例)与HDL-C低组(186例)。对比分析两组患者基线资料、临床资料、在院期间所接受的治疗、死亡情况、随访期间药物使用情况及不良心血管事件发生情况。  结果:HDL-C低组入院后接受再灌注治疗的比例高于HDL-C高组(P  结论:入院时HDL-C水平低的STEMI患者出院后发生不良心血管事件的风险更高。

  4. Electrocardiographic signs of acute myocardial infarction in left bundle branch block

    Directory of Open Access Journals (Sweden)

    Ivanov Igor

    2013-01-01

    Full Text Available Introduction. Acute myocardial infarction is characterized by typical chest pain, electrocardiographic changes in terms of lesion and/or myocardial ischemia and increased cardiac enzymes. It is often difficult to make diagnosis in the presence of non-specific chest pain, the short duration of symptoms and electrocardiographic signs of a complete left bundle branch block. Literature Review. Many authors have tried to set the electrocardiographic criteria that can increase the possibility of correct diagnosis of acute myocardial infarction in such situations. The most widely used and recognized criterion is Sgarbossa scoring system that includes concordant ST segment elevation > 1 mm ST segment, disconcordant denivelation of ST segment > 1 mm in the leads V1-V3 and disconcordant ST segment elevation > 5 mm with acceptable sensitivity and specificity. In subsequent studies, the sensitivity and specificity increased by replacing the third criterion with ST/S ratio < -0.25. Conclusion. The knowledge of certain electrocardiographic signs in patients with acute coronary syndrome and left bundle branch block increases the chances of early diagnosis and the possibility of better and timely treatment.

  5. ESTRATIFICACIÓN DEL RIESGO EN EL SÍNDROME CORONARIO AGUDO CON ELEVACIÓN DEL SEGMENTO ST / Risk stratification in acute coronary syndrome with ST-segment elevation

    Directory of Open Access Journals (Sweden)

    Luis Alberto Rodríguez López

    2010-12-01

    Full Text Available Resumen Introducción y objetivos: El tamaño del infarto y la repercusión sobre la función ventricular constituyen problemas importantes para el pronóstico del paciente. El objetivo de este trabajo fue valorar los factores de mal pronóstico antes del egreso hospitalario mediante la realización de ergometría submaximal y ecocardiograma. Material y método: Se realizó una investigación descriptiva, prospectiva, con 85 pacientes con infarto que recibieron o no terapia trombolítica, en el Hospital Universitario “Celestino Hernández Robau” de Santa Clara, a los cuales se les realizó ergometría y ecocardiograma antes del egreso para detectar variables de mal pronóstico. Resultados: Predominó el sexo masculino (82,2 %, el grupo de edad de 55 años y más (47,1 %, la hipertensión arterial (80 % y el tabaquismo (75,2 %. La localización más frecuente fue la póstero-inferior (78,8 %; la fracción de eyección del ventrículo izquierdo fue mejor en los tratados con trombolíticos, y se detectaron los que tenían una mala función ventricular (10,6 %. El 74,1 % presentó clase funcional I y se identificaron 21 pacientes (24,7 % con mal pronóstico. No hubo diferencia significativa respecto a la terapia trombolítica, pero los pacientes que la recibieron presentaron un mejor comportamiento clínico. Conclusiones: Se encontraron 31 pacientes con prueba de esfuerzo positiva, de mal pronóstico, 5 de ellos con clase funcional III, los cuales presentaron también FEVI disminuida. La prueba de esfuerzo submáxima y el ecocardiograma bidimensional constituyeron herramientas de primera línea en la valoración pronóstica del paciente con IAM, por su existencia en casi todos los centros hospitalarios, bajo costo, poco o ningún riesgo y ser fácil de realizar, y reproducir. / Abstract Introduction and Objectives: Infarct size and the effect on ventricular function are significant problems for the patient's prognosis. The aim of this study was to assess poor prognostic factors prior to hospital discharge by performing submaximal ergometry and echocardiogram. Material and Methods: A descriptive, prospective study was performed on 85 patients with infarction who received or not thrombolytic therapy, in the University Hospital "Dr. Celestino Hernandez Robau" Santa Clara, and who underwent ergometry and echocardiography prior to hospital discharge in order to identify poor prognosis variables. Results: Males were predominant (82.2%, the group aged 55 years and over (47,1 %, hypertension (80% and smoking (75,2 %. The most common location was the posterior-inferior (78.8 % left ventricle ejection fraction was better in patients treated with thrombolysis, and those who had poor ventricular function were identified (10.6%, 74,1 % had functional class I and 21 patients (24,7 % with poor prognosis were identified. There was no significant difference compared to thrombolytic therapy, but the patients who received it had a better clinical behavior. Conclusions: There were 31 patients with positive stress testing and poor prognosis, 5 of them with functional class III, which also showed decreased LVEF. Submaximal exercise testing and two-dimensional echocardiography are first-choice tools in the prognostic assessment of patients with AMI, due to its existence in almost all hospitals, low cost, little or no risk and easy to perform, and reproduce.

  6. Influence of high-dose lipid lowering treatment compared to low-dose lipid lowering treatment on plaque composition assessed by intravascular ultrasound virtual histology in patients with ST-segment elevation acute myocardial infarction

    DEFF Research Database (Denmark)

    Egede, Rasmus; Jensen, Lisette Okkels; Hansen, Henrik Steen;

    2013-01-01

    Aims: The aim of this study was to evaluate the effect of low-dose versus high-dose rosuvastatin therapy on the necrotic core content in coronary plaques of angiographic non-significant lesions as assessed by intravascular ultrasound - virtual histology. Methods and results: Eighty-seven statin-n...... (LDL) cholesterol level was reduced by 31.8% in the low-dose group (from 3.1±0.7 mmol/l to 2.0±0.4 mmol/l, p......Aims: The aim of this study was to evaluate the effect of low-dose versus high-dose rosuvastatin therapy on the necrotic core content in coronary plaques of angiographic non-significant lesions as assessed by intravascular ultrasound - virtual histology. Methods and results: Eighty-seven statin...

  7. 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 a...... of new MI, being admitted with congestive heart failure or death, increased with increasing tertile of MPI, being ≈3 times as high for the third tertile compared with the first tertile (hazard ratio, 2.8; 95% confidence interval, 1.7-4.7; P......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...

  8. Long-Term Outcome of a Routine Versus Selective Invasive Strategy in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome A Meta-Analysis of Individual Patient Data

    NARCIS (Netherlands)

    K.A.A. Fox; T.C. Clayton; P. Damman; S.J. Pocock; R.J. de Winter; J.G.P. Tijssen; B. Lagerqvist; L. Wallentin

    2010-01-01

    Objectives This study was designed to determine: 1) whether a routine invasive (RI) strategy reduces the long-term frequency of cardiovascular death or nonfatal myocardial infarction (MI) using a meta-analysis of individual patient data from all randomized studies with 5-year outcomes; and 2) whethe

  9. Effect on treatment delay of prehospital teletransmission of 12-lead electrocardiogram to a cardiologist for immediate triage and direct referral of patients with ST-segment elevation acute myocardial infarction to primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Sejersten, M.; Sillesen, M.; Hansen, Peter Riis;

    2008-01-01

    . Time to treatment was compared with historic controls. After ECG evaluation, 168 patients (30%) were referred directly for PCI, and 146 of these (87%) underwent emergent catheterization. In referred patients, median time from 911 call to PCI was significantly shorter than in the control group (74 vs...... the hospital. The primary study purpose was to determine whether delays could be decreased in an urban area by transmitting a prehospital 12-lead ECG directly to the attending cardiologist's mobile telephone for rapid triage and transport to a primary percutaneous coronary intervention (PCI) center...... 127 minutes; p <0.001). Accordingly, door-to-PCI time was 63 minutes shorter for referred patients versus controls (34 vs 97 minutes; p <0.001). During transport, 7 patients (4%) experienced ventricular fibrillation; 3 patients (2%), ventricular tachycardia; and 1 patient (0.5%), pulseless electrical...

  10. 影响急性心肌梗死的血运重建因素分析%The influencing factors of receiving revasclarization in the patients with acute ST-segment elevation myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    罗张兴; 白明; 潘明; 张博; 慕仲元; 孟晓雪; 杨波; 高涵翔; 张钲

    2012-01-01

    Objective To evaluate the influencing factor of receiving revascularization in patients with STKMI. Methods A retrospective study, enrolling 1016 patients with STEMI, was carried out to analyse the clinical data including the time from symptoms onset to admission to hospital, etc. Results ( 1 ) Most patients (78. 3% ) showed delay in admission to hospital and 97. 6% of theses patients did not receive primary PCI; (2) Among the 1016 patients, 17.9% received primary PCI, 68. 8% received elective PCI; 1.6% received thrombolysis, and 11.6% received conservative medication. (3) Age, diabetes co-morbidity, occupation, availability of nearby hospital were important factors that lead to patients not receiving primary PCI. Conclusions Delay in admission to hospital is the most important reason which caused patients with STEMI could not receive reperfusion in time.%目的 分析兰州大学第一医院近三年来急性ST段抬高心肌梗死(STEMI)患者的治疗现状及影响患者接受经皮冠状动脉介入(PCI)治疗的因素.方法 回顾性分析2009年至2011年收治的1016名STEMI患者的临床诊治资料.结果 78.3%的患者发病到入院时间>12小时,其中97.6%未能进行急诊PCI.1016名患者中,17.9%的患者接受了急诊PCI治疗,68.8%的患者接受了择期PCI治疗,11.6%的患者仅接受了药物治疗,溶栓的患者仅占1.6%.年龄、合并糖尿病、职业及发病地点距医院的距离均是影响患者接受急诊PCI治疗的原因.结论 患者就诊不及时和转运时间延误是导致STEMI患者不能及时血运重建的主要原因,在时间窗就诊的患者医生的因素是未行血运重建的关键因素.

  11. ST段抬高心肌梗死行介入治疗患者冠脉相对于静脉使用Ⅱb/Ⅲa受体拮抗剂临床效果的Meta分析%Clinical efficacy of intracoronary versus intravenous administration of platelet glycoprotein Ⅱb/Ⅲa receptor antagonists in primary percutaneous coronary intervention of ST-segment elevation myocardial infarction: a systematic review

    Institute of Scientific and Technical Information of China (English)

    尹建; 徐强; 司良毅

    2012-01-01

    目的 系统评价ST段抬高心肌梗死(ST segment elevation myocardial infarction,STEMI)行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)患者,冠脉较静脉使用血小板糖蛋白(platelet glycoprotein,GP)Ⅱb/Ⅲa受体拮抗剂的有效性及安全性.方法 2011年9月至10月,计算机检索美国国立生物医学信息中心PubMed数据库、Cochrane图书馆临床对照试验数据库、荷兰医学文摘embase数据库、中国生物医学文献数据库(CBM)和中国期刊全文数据库(CJFD).同时检索相关网站,尽量获取会议摘要及灰色文献.使用RevMan 5.1软件对纳入研究进行Meta分析.结果 共纳入11篇文献,总计1569例患者.Meta分析结果示:冠脉较静脉使用GPⅡb/Ⅲa受体拮抗剂能显著改善STEMI患者术后心肌梗死溶栓试验(TIMI)3级血流(RR= 1.08,95% CI为1.04~1.13,P<0.01),TIMI心肌组织灌注分级(TMPG)3级血流(RR= 1.37,95%CI为1.16 ~1.63,P<0.01),左室射血分数(MD =0.04,95% CI为0.02 ~0.06,P<0.01),降低主要不良心脏事件(MACE)发生率(RR=0.48,95% CI为0.34 ~ 0.69,P<0.01),同时不增加主要出血并发症(RR =1.04,95% CI为0.55~1.95,P=0.90).阿昔单抗在此基础上能进一步降低1个月时死亡率(RR =0.45,95% CI为0.21~0.99,P=0.05).结论 冠脉较静脉途径使用GPⅡb/Ⅲa受体拮抗剂能改善STEMI行PCI治疗患者术后罪犯血管再通、心肌灌注及左心室功能恢复,降低主要不良心脏事件发生率,同时不增加主要出血并发症.%Objective To evaluate the efficiency and safety of intracoronary versus intravenous administration of platelet glycoprotein IIb/IIIa (GP Ilb/IIIa) receptor antagonists in patients with ST-segment elevation myocardial infarction (STEMI) received percutaneous coronary intervention (PCI). Methods Randomized controlled trials were searched in the following databases including PubMed, Excerpta Medica Database (Embase), Cochrane library

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

    Directory of Open Access Journals (Sweden)

    Alberto Dominguez-Rodriguez

    2014-01-01

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

  13. Acute coronary syndrome: analysis of two case reports

    Directory of Open Access Journals (Sweden)

    Marco Mascellanti

    2009-12-01

    Full Text Available The patients presenting acute coronary syndrome without ST segment elevation can have a short and long-term risk of death or recurrent ischemic events. Therefore, the evaluation of risk is an essential step in the management of such patients. We report two cases – a 86-year-old male, and a 46-year-old one – with acute coronary syndrome with non-ST-segment elevation, showing the importance of risk assessment to determine management strategy. Two risk profile scores were used: TIMI score and GRACE score. Routine use of validated risk score may facilitate more appropriate tailoring of intensive therapies, but the clinical reasoning of the physician is essential to take right decisions.

  14. Acute Myocardial Infarction Caused by Filgrastim: A Case Report

    Directory of Open Access Journals (Sweden)

    Cemil Bilir

    2012-01-01

    Full Text Available Common uses of the granulocyte-colony stimulating factors in the clinical practice raise the concern about side effects of these agents. We presented a case report about an acute myocardial infarction with non-ST segment elevation during filgrastim administration. A 73-year-old man had squamous cell carcinoma of larynx with lung metastasis treated with the chemotherapy. Second day after the filgrastim, patient had a chest discomfort. An ECG was performed and showed an ST segment depression and negative T waves on inferior derivations. A coronary angiography had showed a critical lesion in right coronary arteria. This is the first study thats revealed that G-CSF can cause acute myocardial infarction in cancer patients without history of cardiac disease. Patients with chest discomfort and pain who are on treatment with G-CSF or GM-CSF must alert the physicians for acute coronary events.

  15. Polycythemia vera presenting as acute myocardial infarction: An unusual presentation

    OpenAIRE

    Bahbahani, Hussain; Aljenaee, Khaled; Bella, Abdelhaleem

    2014-01-01

    Acute myocardial infarction (AMI) is usually seen in the setting of atherosclerosis and its associated risk factors. Myocardial infarction in the young poses a particular challenge, as the disease is less likely, due to atherosclerosis. We report the case of a 37-year-old female patient who presented with ST segment elevation anterolateral AMI. The only abnormality on routine blood investigation was raised hemoglobin and hematocrit. After further testing, she was diagnosed according to the Wo...

  16. 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

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

    Directory of Open Access Journals (Sweden)

    You Jia

    2015-01-01

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

  18. Impact of Timing of Eptifibatide Administration on Preprocedural Infarct-Related Artery Patency in Acute STEMI Patients Undergoing Primary PCI

    OpenAIRE

    Dharma, Surya; Firdaus, Isman; Danny, Siska Suridanda; Juzar, Dafsah A.; Wardeh, Alexander J.; Jukema, J Wouter; van der Laarse, Arnoud

    2014-01-01

    The appropriate timing of eptifibatide initiation for acute ST segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) remains unclear. This study aimed to analyze the impact of timing of eptifibatide administration on infarct-related artery (IRA) patency in STEMI patients undergoing primary PCI. Acute STEMI patients who underwent primary PCI (n = 324) were enrolled in this retrospective study; 164 patients received eptifibatide bol...

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

    Directory of Open Access Journals (Sweden)

    Grossman P Michael

    2010-02-01

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

  20. ST-elevations-myokardieinfarkt efter terapeutisk adrenalininjektion

    DEFF Research Database (Denmark)

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

    2006-01-01

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

  1. Efficacy comparison of combined intracoronary administration of high-dose adenosine and tirofiban versus intracoronary tirofiban during primary percutaneous coronary intervention in patients with acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    佟子川

    2013-01-01

    Objective To compare the efficacy of intracoronary administration of combined high-dose adenosine and tirofiban versus intracoronary tirofiban during primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction.Methods Consecutive 258 patients with acute ST-segment elevation myocardial infarction (STEMI) underwent primary PCI,treated with thrombus aspiration and then intracoronary tirofiban,and were randomly divided into adenosine group (n=130) and con-

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

    DEFF Research Database (Denmark)

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

    2014-01-01

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

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

    DEFF Research Database (Denmark)

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

    2010-01-01

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

  4. 21 CFR 870.1025 - Arrhythmia detector and alarm (including ST-segment measurement and alarm).

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Arrhythmia detector and alarm (including ST... Diagnostic Devices § 870.1025 Arrhythmia detector and alarm (including ST-segment measurement and alarm). (a) Identification. The arrhythmia detector and alarm device monitors an electrocardiogram and is designed to...

  5. Significance of lead aVR in acute coronary syndrome

    Institute of Scientific and Technical Information of China (English)

    Akira; Tamura

    2014-01-01

    The 12-lead electrocardiogram(ECG)is a crucial tool in the diagnosis and risk stratification of acute coronary syndrome(ACS).Unlike other 11 leads,lead aVR has been long neglected until recent years.However,recent investigations have shown that an analysis of ST-segment shift in lead aVR provides useful information on the coronary angiographic anatomy and risk stratification in ACS.ST-segment elevation in lead aVR can be caused by(1)transmural ischemia in the basal part of the interventricular septum caused by impaired coronary blood flow of the first major branch originating from the left anterior descending coronary artery;(2)transmural ischemia in the right ventricular outflow tract caused by impaired coronary blood flow of the large conal branch originating from the right coronary artery;and(3)reciprocal changes opposite to ischemic or non-ischemic ST-segment depression in the lateral limb and precordial leads.On the other hand,ST-segment depression in lead aVR can be caused by transmural ischemia in the inferolateral and apical regions.It has been recently shown that an analysis of T wave in lead aVR also provides useful prognostic information in the general population and patients with prior myocardial infarction.Cardiologists should pay more attention to the tracing of lead aVR when interpreting the12-lead ECG in clinical practice.

  6. Limited value of recovery phase-limited ST segment depression of treadmill exercise test

    Institute of Scientific and Technical Information of China (English)

    Yang Hongbo; Huang Zheyong; Lou Yi; Shen Yunli; Qian Juying; Ge Junbo

    2014-01-01

    Background Clinical meaning of recovery phase limited ST segment depression of a treadmill exercise test is controversial.The aim of this study was to re-assess the diagnostic and prognostic value of ST segment depression during the recovery phase with the active phase of a treadmill exercise test in suspected coronary artery disease patients.Methods Clinical,exercise and angiographic data were retrospectively collected from 602 patients in the study.Five hundred and seventy-six patients developed ST segment depression during the active phase of the treadmill exercise test (group 1) and 26 patients developed ST segment depression only during the recovery phase (group 2).Results With similar major clinical features,the prevalence of significant coronary artery stenosis and average Gensini scores were lower in the recovery phase-limited depression patients (group 2 vs.group 1,50.0% vs.66.9%,P=0.031 and group 2 vs.group 1,1.5 vs.8.5,P=0.04).At a median follow up of 50.9 months for 22 group 2 and 34.8 months for 438 group 1 patients,the prevalence of total cardiac events was higher in group 1 than in group 2 patients (RR 1.60,95% Cl 1.00-2.54,P=0.049).Conclusion The present study provides preliminary evidence that the diagnostic and prognostic value of recovery phaselimited ST segment depression of treadmill exercise test is limited.

  7. Effect of precordial electrocardiographic electrode placement on ST-segment measurement during exercise.

    Science.gov (United States)

    Bertolet, B D; Boyette, A F; Mardis, M; Hill, J A

    1995-04-01

    Research protocols often utilize serial exercise testing to examine the efficacy of anti-ischemic therapies. These tests, however, are prone to multiple sources of bias. This investigation sought to determine the influence of varying precordial electrocardiographic (ECG) electrode placement on the detection of exercise-induced ST-segment shifts. Fifteen coronary artery disease patients with abnormal exercise tests were studied. Based on the previous exercise test, the precordial electrode position exhibiting the greatest ST-segment shift was selected as the reference electrode. Four additional electrodes were placed around this reference electrode and exercise testing was performed. ECG strips were recorded every minute. The time-to-onset and -offset of ischemic-type ST-segment depression was recorded. ST-segment depression was recorded during exercise from the reference electrode in 12 of 15 patients. Ischemic-type ST-depression was also recorded in each of these 12 patients with the surrounding electrodes; however, the time-to-onset detected by all four surrounding electrodes concurred in only 5 of 12 (42%) patients. The time-to-offset of the ST-segment depression concurred in 9 of 12 (75%) patients. Serial ECGs recorded from similar but not exactly the same precordial ECG electrode position should yield similar results for the detection of ischemia, but time-to-onset or -offset of ischemia may differ by 60 s or more. Small changes in the time-to-onset and -offset of ischemia should not be considered reliable indicators of anti-ischemia efficacy.

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

    International Nuclear Information System (INIS)

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

  9. Acute Myocardial Infarction in a 26-Year-Old Patient With Familial Hypercholesteremia.

    Science.gov (United States)

    Miyayama, Takeshi; Miura, Shin-Ichiro; Komaki, Tomo; Kuwano, Takashi; Morii, Joji; Nishikawa, Hiroaki; Saku, Keijiro

    2016-07-01

    A 26-year-old male suffered sustained chest pain. Electrocardiogram showed ST-segment elevation in the anteroseptal wall and reciprocal ST-segment change in the inferior wall. The troponin-I level and the white blood cell count were elevated. We gave a diagnosis of acute myocardial infarction. He underwent urgent coronary angiography, which revealed 90% diffuse stenosis in the middle right coronary artery and total occlusion in the proximal left anterior descending coronary artery (LAD). Since the electrocardiogram indicated that the culprit lesion was in the proximal LAD, we performed percutaneous coronary intervention. The coronary flow in the LAD was classified as thrombolysis in myocardial infarction trial 3. His coronary risk factors were obesity, smoking, family history, hypertension and diabetes, in addition to heterozygous familial hypercholesteremia (FH). Herein, we describe the case of a young patient with acute anteroseptal myocardial infarction and discuss the potential importance of controlling cholesterol levels in FH. PMID:27298669

  10. Successful Percutaneous Coronary Intervention in a Centenarian Patient With Acute Myocardial Infarction

    OpenAIRE

    Lee, Ki Hong; Jeong, Myung Ho; Chung, Cho Yun; Kim, Donghan; Lee, Min Goo; Park, Keun-Ho; Sim, Doo Sun; Yoon, Nam Sik; Yoon, Hyun Ju; Kim, Kye Hun; Hong, Young Joon; Kim, Ju Han; Ahn, Youngkeun; Cho, Jeong Gwan; Park, Jong Chun

    2012-01-01

    Despite an increasing prevalence and burden of disease in the elderly, little is known about the management and outcomes of acute coronary syndromes in this group. We report the case of a 101-year-old female patient with a non-ST segment elevation myocardial infarction. Coronary angiography showed a total occlusion of the proximal right coronary artery (RCA), and a significant stenosis in the proximal to mid left anterior descending artery (LAD). Despite a very poor initial clinical status, a...

  11. METOPROLOL AND CARVEDILOL IN THERAPY OF ACUTE MYOCARDIAL INFARCTION: WHEN AND WHICH DRUG TO PREFER

    Directory of Open Access Journals (Sweden)

    B. N. Garifullin

    2009-01-01

    Full Text Available Results of large randomized clinical trails on beta-blockers therapy of myocardial infarction (MI with ST segment elevation (COMMIT/CCS-2, CAPRICORN are analyzed. Last changes in guidelines regarding beta-blockers prescription to patients with MI are presented. Data of the studies comparing influence of metoprolol tartrate and carvedilol on MI pathogenesis are presented. Possible indications and treatment schemes for carvedilol in patients with acute MI are discussed.

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

    Directory of Open Access Journals (Sweden)

    Ostojić Marina M.

    2015-01-01

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

  13. 冠状动脉靶血管楔压测定法评价ST段抬高性心肌梗死患者冠状动脉侧支循环形成对心肌存活程度的影响%Target vessel coronary artery wedge pressure measurement method ST-segment elevation myocardial infarction in patients with coronary collateral circulation on the degree of myocardial viability

    Institute of Scientific and Technical Information of China (English)

    郑振国; 朱皓; 王俊杰; 张波; 尹达; 王少鹏; 张妍; 黄榕翀; 周旭晨

    2013-01-01

    Objective To measure target vessel coronary artery wedge pressure changes in patients with the ST-segment elevation myocardial infarction (STEMI) having underwent primary percutaneous coronary intervention (PCI),compare it with positron emission tomography/X-ray computed tomography (PET-CT) myocardial perfusion imaging,and investigate the clinical significance of target vessel coronary artery wedge pressure level on myocardial viability assessment.Methods Thirty-three patients with first STEMI after primary PCI were collected.According to Rentrop coronary collateral circulation classification method,they were divided into two groups,group 1 (Rentrop collateral grade 0,23 cases) and group 2 (Rentrop collateral grade 1-3,10 cases).Myocardial infarction trial flow and myocardial perfusion grade of the infarct-related artery before and after PCI was evaluated,and coronary artery wedge pressure (Pcw)/mean aortic pressure (Pa) changes were observed by pressure guide wire.7 d after PCI,all patients received PET-CT detection.Results The Pcw/Pa was significantly correlated with 18F-fluorodeoxyglucose (18F-FDG) uptake rate in group 1 (r =-0.561,P =0.010),but there was no correlation in group 2 (r =-0.262,P =0.464).Best cut off value of the Pcw/Pa for 50% of 18F-FDG uptake was 0.33 (area under cure =0.667,sensitivity 42.1%,specificity 92.9%).Conclusions The Pcw/Pa in STEMI may be a useful indicator of the severity of microvascular damage of infarct-related myocardium in patients without developed collateral circulation,but it may not represent the severity of microvascular damage in patients with developed collateral circulation.%目的 通过测定ST段抬高性心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)后冠状动脉靶血管楔压的变化,并与正电子发射断层显像/X线计算机体层成像(PET-CT)心肌灌注显影进行对照,探讨冠状动脉靶血管楔压测定对心肌存活程度评价的临床意义.方法 33例接受了急

  14. Impact of high loading-dose atorvastatin pre-treatment before primary percutaneous coronary intervention on coronary flow in patients with ST segment elevation myocardial infarction%直接经皮冠状动脉介入治疗术前负荷剂量阿托伐他汀治疗对急性心肌梗死患者近期预后的影响

    Institute of Scientific and Technical Information of China (English)

    郑博; 王新刚; 龚艳君; 李建平; 陈明; 霍勇; 洪涛

    2013-01-01

    Objective This study sought to investgate the impact of high loading-dose atorvastatin pre-treatment in patients with ST-segment elevation myocardial infarction ( STEMI) undergoing primary percutaneous coronary intervention ( PCI ) on coronary reperfusion, short-term clinical outcome and safety. Methods We collected consecutive patients with STEMI in our hospital from January 2010 to March 2011 ,83 patients who did not receive any statin therapy before admission and only received atorvastatin after admission were included. Patients were divided in 2 groups : those who received atorvastatin 80 mg before primary PCI (n = 41) and those who did not (n =42). The primary end point included thrombolysis in myocardial infarction flow grade, corrected thrombolysis in myocardial infarction frame count, and myocardial blush grade after PCI. Secondary end point was 30-day incidence of MACE including cardiovascular death, nonfatal MI, and target vessel revascularization. The safety end point was the level of liver enzyme, creatine kinase and serum creatinine. Results Baseline clinical and procedural characteristics were similar between the 2 groups. The proportion of thrombolysis in myocardial infarction flow grade 3 was higher in the 80-mg atorvastatin arm ( 87. 8% vs. 64. 3% ,x2 = 6. 28 , P = 0. 02 ) , and corrected thrombolysis in myocardial infarction frame count was also lower in the 80-mg atorvastatin arm (21. 72 ±9. 42 vs. 32. 64 ± 15. 51, t = -3. 87, P < 0. 001 ) . Simultaneously, myocardial blush grade were higher in the 80 mg atorvastatin arm (2,71+0.64 vs. 2. 15 ± 0. 74, t = 3. 68, P < 0. 001 ). MACE occurred in 2 (4.9%) and 2 (4.8%) patients in the atorvastain 80 mg pre-treatment and control arm, respectively (x2 =0. 001 ,P = 0. 926). There was not significant difference of liver enzyme, creatine kinase and serum creatinine between 2 groups. Multivariate analysis showed that high loading-dose atorvastatin pre-treatment was associated with an odds ratio of 0. 22

  15. 24 Hour ST Segment Analysis in Transient Left Ventricular Apical Ballooning

    OpenAIRE

    Frank Bode; Christof Burgdorf; Heribert Schunkert; Volkhard Kurowski

    2013-01-01

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

  16. The SYNTAX score predicts early mortality risk in the elderly with acute coronary syndrome having primary PCI.

    OpenAIRE

    Scherff F.; Vassalli G.; Sürder D.; Mantovani A; Corbacelli C.; Pasotti E.; Klersy C.; Auricchio A.; Moccetti T.; Pedrazzini G.B.

    2011-01-01

    BACKGROUND: The SYNTAX score (SXscore), an angiographic score reflecting coronary lesion complexity, predicts clinical outcomes in patients with left main or multivessel disease, and in patients with ST-segment elevation myocardial infarction undergoing primary PCI. The clinical SXscore (CSS) integrates the SXscore and clinical variables (age, ejection fraction, serum creatinine) into a single score. We analyzed these scores in elderly patients with acute coronary syndrome (ACS) undergoing pr...

  17. Outcomes of after-hours versus regular working hours primary percutaneous coronary intervention for acute myocardial infarction

    OpenAIRE

    Graham, Michelle M; Ghali, William A.; Southern, Danielle A.; Traboulsi, Mouhieddin; Knudtson, Merril L.; ,

    2011-01-01

    Background Primary percutaneous coronary intervention (PCI) is a proven therapy for acute ST-segment elevation myocardial infarction. However, outcomes associated with primary PCI may differ depending on time of day. Methods and results Using the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease, a clinical data-collection initiative capturing all cardiac catheterisation patients in Alberta, Canada, the authors described and compared crude and risk-adjusted survival...

  18. Deferred stent implantation in patients with ST-segment elevation myocardial infarction

    DEFF Research Database (Denmark)

    Kelbæk, Henning; Engstrøm, Thomas; Ahtarovski, Kiril A;

    2013-01-01

    Disturbance in the flow of an infarct-related artery due to embolisation of thrombus and plaque material occurs frequently during primary percutaneous coronary intervention (PCI) and is associated with impaired prognosis. The aim of the present study was to minimise the risk of embolisation durin...

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

    Institute of Scientific and Technical Information of China (English)

    于富军; 傅向华; 卫亚丽; 李寿霖; 肖蕴陟; 丁超; 赵战勇

    2004-01-01

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

  20. Association between Angiotensin-Converting Enzyme Inhibitors and Troponin in Acute Coronary Syndrome

    Directory of Open Access Journals (Sweden)

    Luiz Minuzzo

    2014-12-01

    Full Text Available Background: Cardiovascular disease is the leading cause of mortality in the western world and its treatment should be optimized to decrease severe adverse events. Objective: To determine the effect of previous use of angiotensin-converting enzyme inhibitors on cardiac troponin I measurement in patients with acute coronary syndrome without ST-segment elevation and evaluate clinical outcomes at 180 days. Methods: Prospective, observational study, carried out in a tertiary center, in patients with acute coronary syndrome without ST-segment elevation. Clinical, electrocardiographic and laboratory variables were analyzed, with emphasis on previous use of angiotensin-converting enzyme inhibitors and cardiac troponin I. The Pearson chi-square tests (Pereira or Fisher's exact test (Armitage were used, as well as the non-parametric Mann-Whitney's test. Variables with significance levels of 0.5 ng / mL were high blood glucose at admission (p = 0.0034 and ST-segment depression ≥ 0.5 mm in one or more leads (p = 0.0016. The use of angiotensin-converting inhibitors prior to hospitalization was associated with troponin ≤ 0.5 ng / mL (p = 0.0482. The C-statistics for this model was 0.77. Conclusion: This study showed a correlation between prior use of angiotensin-converting enzyme inhibitors and reduction in the myocardial necrosis marker troponin I in patients admitted for acute coronary syndrome without ST-segment elevation. However, there are no data available yet to state that this reduction could lead to fewer severe clinical events such as death and re-infarction at 180 days.

  1. Rivaroxaban for Preventing Atherothrombotic Events in People with Acute Coronary Syndrome and Elevated Cardiac Biomarkers: An Evidence Review Group Perspective of a NICE Single Technology Appraisal.

    Science.gov (United States)

    Pandor, Abdullah; Pollard, Daniel; Chico, Tim; Henderson, Robert; Stevenson, Matt

    2016-05-01

    As part of its Single Technology Appraisal process, the National Institute for Health and Care Excellence (NICE) invited the company that manufactures rivaroxaban (Xarelto, Bayer) to submit evidence of the clinical and cost effectiveness of rivaroxaban for the prevention of adverse outcomes in patients after the acute management of acute coronary syndrome (ACS). The School of Health and Related Research Technology Appraisal Group at the University of Sheffield was commissioned to act as the independent Evidence Review Group (ERG). The ERG produced a critical review of the evidence for the clinical and cost effectiveness of the technology, based upon the company's submission to NICE. The evidence was derived mainly from a randomised, double-blind, phase III, placebo-controlled trial of rivaroxaban (either 2.5 or 5 mg twice daily) in patients with recent ACS [unstable angina, non-ST segment elevation myocardial infarction (NSTEMI) or ST segment elevation myocardial infarction (STEMI)]. In addition, all patients received antiplatelet therapy [aspirin alone or aspirin and a thienopyridine either as clopidogrel (approximately 99 %) or ticlopidine (approximately 1 %) according to national or local guidelines]. The higher dose of rivaroxaban (5 mg twice daily) did not form part of the marketing authorisation. A post hoc subgroup analysis of the licensed patients who had ACS with elevated cardiac biomarkers (that is, patients with STEMI and NSTEMI) without prior stroke or transient ischaemic stroke showed that compared with standard care, the addition of rivaroxaban (2.5 mg twice daily) to existing antiplatelet therapy reduced the composite endpoint of cardiovascular mortality, myocardial infarction or stroke, but increased the risk of major bleeding and intracranial haemorrhage. However, there were a number of limitations in the evidence base that warrant caution in its interpretation. In particular, the evidence may be confounded because of the post hoc subgroup

  2. Pancreatitis with Electrocardiographic Changes Mimicking Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Paul Khairy

    2001-01-01

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

  3. DISPERSIÓN DEL INTERVALO QT CORREGIDO EN LA EVOLUCIÓN DE PACIENTES CON SÍNDROMES CORONARIOS AGUDOS / Corrected QT interval dispersion in the evolution of patients with acute coronary syndromes

    Directory of Open Access Journals (Sweden)

    Carlos J. Fabelo Mora

    2011-06-01

    Full Text Available Introduction and Objectives: Acute myocardial infarc-tion remains a major challenge for health systems. In the classic concept of the ischemic cascade, the earliest event is the QT interval prolongation, which was previously reported in patients with unstable angina and ST elevation myocardial infarction. There has been speculation that the normalization of this interval in patients undergoing angioplasty, is a marker of successful reperfusion, thus the objective of this research is to characterize the corrected QT interval dispersion and its association with adverse outcomes in patients with acute coronary syndromes. Method: The corrected QT interval dispersion was analyzed in patients admitted to the Hospital "Comandante Manuel Fajardo Rivero" with an acute coronary syndrome from January to December 2009. The results were analyzed to provide inferential information on the basis of the statistical assessment of the SPSS processor, version 15.0. Results: The ST-segment elevation syndrome was the clinical form that included the most patients, but prolonged dispersion prevailed in those with unclassifiable syndrome, an atypical clinical presen-tation and a wrong electrocardiogram, similar behavior to that of the patients with a non-ST segment elevation syndrome, but not in those with ST segment elevation. Mortality, cardiac reinfarction, and need for myocardial revascularization were significantly associated with prolonged dispersion of the corrected QT interval. Conclusions: The prolonged dispersion of this interval could be an independent predictor of increased cardiovascular risk.

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

    NARCIS (Netherlands)

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

    2015-01-01

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

  5. Effect of ranolazine, an antianginal agent with novel electrophysiological properties, on the incidence of arrhythmias in patients with non ST-segment elevation acute coronary syndrome: results from the Metabolic Efficiency With Ranolazine for Less Ischemia in Non ST-Elevation Acute Coronary Syndrome Thrombolysis in Myocardial Infarction 36 (MERLIN-TIMI 36) randomized controlled trial.

    NARCIS (Netherlands)

    Scirica, B.M.; Morrow, D.A.; Hod, H.; Murphy, S.A.; Belardinelli, L.; Hedgepeth, C.M.; Molhoek, P.; Verheugt, F.W.A.; Gersh, B.J.; McCabe, C.H.; Braunwald, E.

    2007-01-01

    BACKGROUND: Ranolazine, a piperazine derivative, reduces ischemia via inhibition of the late phase of the inward sodium current (late I(Na)) during cardiac repolarization, with a consequent reduction in intracellular sodium and calcium overload. Increased intracellular calcium leads to both mechanic

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

    Science.gov (United States)

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

    2011-10-01

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

  7. Effect of rosuvastatin dose-loading on serum sLox-1, hs-CRP, and postoperative prognosis in diabetic patients with acute coronary syndromes undergoing selected percutaneous coronary intervention (PCI)

    OpenAIRE

    Jiao, Yungen; Hu, Feng; Zhang, Zhengang; Gong, Kaizheng; Sun, Xiaoning; Li, Aihua; Liu, Naifeng

    2015-01-01

    Objective: To investigate the effect of rosuvastatin dose-loading on serum levels of lectin-like oxidized low-density lipoprotein receptor-1 (Lox-1) and high-sensitivity c-reactive protein (hs-CRP) and postoperative prognosis in patients with diabetes and non-ST segment elevation acute coronary syndromes (NSTEACS) undergoing selected percutaneous coronary intervention (PCI). Methods: A total of 72 patients with diabetes and NSTEACS were randomized to either the group treated with 20 mg rosuva...

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

    Science.gov (United States)

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

    2016-07-15

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

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

    Directory of Open Access Journals (Sweden)

    Choi Joon

    2012-09-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  12. Sgarbossa Criteria are Highly Specific for Acute Myocardial Infarction with Pacemakers

    Directory of Open Access Journals (Sweden)

    Maloy, Kevin R

    2010-09-01

    Full Text Available Objective: In 1996 Sgarbossa reviewed 17 ventricular-paced electrocardiograms (ECGs in acute myocardial infarction (AMI for signs of ischemia. Several characteristics of the paced ECG were predictive of AMI. We sought to evaluate the criteria in ventricular-paced ECGs in an emergency department (ED cohort.Methods: Ventricular-paced ECGs in patients with elevated cardiac markers within 12 hours of the ED ECG and a diagnosis of AMI were identified retrospectively (n=57 and compared with a control group of patients with ventricular-paced ECGs and negative cardiac markers (n=99. A blinded board certified cardiologist reviewed all ECGs for Sgarbossa criteria. This study was approved by the institutional review board.Results: Application of Sgarbossa’s criteria to the paced ECGs revealed the following: 1 The sensitivity of “ST-segment elevation of 1 mm concordant with the QRS complex” was unable to be calculated as no ECG fit this criterion; 2 For “ST-segment depression of 1 mm in lead V1, V2, or V3,” the sensitivity was 19% (95% CI 11-31%, specificity 81% (95% CI 72-87%, with a likelihood ratio of 1.06 (0.63-1.64; 3 For “ST-segment elevation >5mm discordant with the QRS complex,” the sensitivity was 10% (95% CI 5-21%, specificity 99% (95% CI 93-99%, with a likelihood ratio of 5.2 (1.3 - 21.Conclusion: In our review of ventricular-paced ECGs, the most clinically useful Sgarbossa criterion in identifying AMI was ST-segment elevation >5mm discordant with the QRS complex. This characteristic may prove helpful in identifying patients who may ultimately benefit from early aggressive AMI treatment strategies. [West J Emerg Med. 2010; 11(4:354-357.

  13. The role of the ECG in diagnosis, risk estimation, and catheterization laboratory activation in patients with acute coronary syndromes: a consensus document.

    Science.gov (United States)

    Birnbaum, Yochai; Nikus, Kjell; Kligfield, Paul; Fiol, Miguel; Barrabés, Jose Antonio; Sionis, Alessandro; Pahlm, Olle; Niebla, J Garcia; de Luna, Antonio Bayès

    2014-09-01

    The electrocardiogram (ECG) is the most widely used imaging tool helping in diagnosis and initial management of patients presenting with symptoms compatible with acute coronary syndrome. Acute ischemia affects the configuration of the QRS complexes, the ST segments and the T waves. The ECG should be read along with the clinical assessment of the patient. ST segment elevation (and ST depression in leads V1 -V3 ) in patients with active symptoms usually indicates acute occlusion of an epicardial artery with ongoing transmural ischemia. These patients should be triaged for emergent reperfusion therapy per current guidelines. However, many patients have ST segment elevation secondary to nonischemic causes. ST depression in leads other than V1 -V3 usually are indicative of subendocardial ischemia secondary to subocclusion of the epicardial artery, distal embolization to small arteries or spasm supply/demand mismatch. ST depression may also be secondary to nonischemic etiologies, such as left ventricular hypertrophy, cardiomyopathies, etc. Knowing the clinical scenario, comparison to previous ECG and subsequent ECGs (in cases that there are changes in the quality or severity of symptoms) may add in the diagnosis and interpretation in difficult cases. This review addresses the different ECG patterns, typically seen in patients with active symptoms, after resolution of symptoms and the significance of such changes when seen in asymptomatic patients.

  14. Continuous Digital 12-Lead ST -Segment Monitoring in Acute Myocardial Infarction

    NARCIS (Netherlands)

    R.F. Veldkamp (Rolf)

    1995-01-01

    textabstractIn 1787 Aloysio Luigi Galvani (1737-1798), at that time Professor of Anatomy at the University of Bologna, demonstrated that the muscles of the hind limbs of a frog manifested "electromotive phenomena." A partly dissected frog's leg with a metal scalpel accidentally left in contact with

  15. Dynamic computer-assisted ST segment monitoring in patients with acute coronary syndromes

    NARCIS (Netherlands)

    A.P.J. Klootwijk (Peter)

    1998-01-01

    textabstractSince the first recording of the human electrical activity of the heart by Waller in 1887 1 and the invention of the electrocardiograph by Willem Einthoven in 1902 2 the recording of the electrocardiogram (ECG) has evolved into one of the most important noninvasive diagnostic techniques

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

    DEFF Research Database (Denmark)

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

    2013-01-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

  18. Acute multivessel coronary artery occlusion: a case report

    Directory of Open Access Journals (Sweden)

    Gan Feng

    2012-09-01

    Full Text Available Abstract Background In terms of clinical and angiographic findings, multiple simultaneous coronary occlusions in acute myocardial infarction are infrequent, and the mechanism of the occlusions is unclear. Case presentation We herein report a rare case of two simultaneously occluded coronary arteries, one of which subsequently underwent spontaneous lysis. An 88-year-old man had a 3-hour attack of acute crushing retrosternal chest pain. His first electrocardiogram showed ST-segment elevation in the inferior (II, III, and aVF and anterior (V3–V6 leads. His second electrocardiogram in the cardiac care unit showed ST-segment elevation in the inferior leads but ST-segment depression in the anterior leads. Emergency coronary angiography revealed that the right coronary artery was acutely and totally occluded at the midportion and that the proximal and midportion of the left anterior descending coronary artery had an acute thrombus. According to his electrocardiogram and coronary angiography findings, we inferred that the right coronary artery and left anterior descending coronary artery first totally occluded simultaneously, and then the thrombus in the left anterior descending coronary artery spontaneously underwent partial lysis. Therefore, intervention of the right coronary artery was performed followed by injection of glycoprotein IIB-IIIA inhibitor into the left anterior descending coronary artery. He had an uneventful hospital course and was discharged home 10 days later. Conclusion Because patients with multivessel coronary artery occlusion are often in serious condition, abnormal electrocardiographic results must be identified and affected vessel should be opened timely and efficiently to save the myocardium and reduce complications such as congestive heart failure.

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

    Directory of Open Access Journals (Sweden)

    K. A. Kireev

    2015-01-01

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

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

    Science.gov (United States)

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

    2013-05-01

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

  1. The impact of elevated serum creatinine on the prognosis of acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    李帮清

    2006-01-01

    Objective To evaluate the clinical features and outcomes in patients suffering from acute myocardial infarction combined with elevated serum creatinine. Methods We enrolled 340 consecutive patients suffering from acute myocardial infarction admitted into our hospital from 2003.2.1 -2004.8.31. The patients were divided into the following 2 groups, 269 patients in a group with normal serum creatinine and 71 patients in a group with elevated serum creatinine, according to the normal limit of

  2. 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.

  3. System delay and timing of intervention in acute myocardial infarction (from the Danish Acute Myocardial Infarction-2 [DANAMI-2] trial)

    DEFF Research Database (Denmark)

    Nielsen, Peter Haubjerg; Terkelsen, Christian Juhl; Nielsen, Torsten Toftegård;

    2011-01-01

    The interval from the first alert of the healthcare system to the initiation of reperfusion therapy (system delay) is associated with mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention (pPCI). The importance of system delay...... in patients treated with fibrinolysis versus pPCI has not been assessed. We obtained data on system delay from the Danish Acute Myocardial Infarction-2 study, which randomized 1,572 patients to fibrinolysis or pPCI. The study end points were 30-day and 8-year mortality. The short system delays were...

  4. Parvovirus B19-Induced Constellation of Acute Renal Failure, Elevated Aminotransferases and Congestive Heart Failure

    Directory of Open Access Journals (Sweden)

    Iain W McAuley

    1997-01-01

    Full Text Available This report details a case of acute renal failure and elevated aminotransferases with subsequent development of congestive heart failure in a patient with history of exposure to parvovirus B19 and serological evidence of acute infection with this agent. This constellation of organ involvement has not been previously reported in the literature.

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

    Directory of Open Access Journals (Sweden)

    Bardaji Alfredo

    2010-01-01

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

  6. Combined Therapy with Chinese Medicine and Percutaneous Transradial Coronary Intervention for a Centenarian Patient with Acute Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    王磊; 张敏州; 杨广

    2009-01-01

    There are not enough clinical data about centenarians with acute myocardial infarction(AMI) undergoing percutaneous coronary intervention(PCI).A 104-year-old woman exhibited sharp chest pain and severe dyspnea.In routine examinations,her electrocardiogram showed 1-3 mm ST-segment elevation from V1 to V4 leads,the cardiac enzymes were also elevated:creatine kinase(CK)-MB was 45.7 U/L,and cardiac specific troponin I was 40μg/L.A two-dimensional echocardiography showed anteroseptal akinesia with severely de...

  7. Markedly elevated plasma D-dimer and the prevalence of acute pulmonary embolus

    Directory of Open Access Journals (Sweden)

    Andrew W. Bowman

    2011-11-01

    Full Text Available Objective. To evaluate if increasingly elevated levels of plasma D-dimer are associated with higher prevalence of acute pulmonaryembolus (PE. Patients and Methods. A retrospective study wasconducted evaluating all PE protocol CT examinations performed inlow-to-intermediate risk emergency department and hospitalized patients during 2007. All PE protocol CT reports were reviewed for thepresence or absence of acute PE. Th e charts of all of these subjectswere then reviewed for quantitative plasma D-dimer values, measuredin mg/ml Fibrinogen Equivalent Units, drawn within one day prior tothe CT exam. Th e prevalence of acute PE at different D-dimer threshold results was then evaluated using D-dimer groups as follows: < 1.0 mg/ml, ≥ 1.0 but < 2.0 mg/ml, ≥ 2.0 but < 4.0 mg/ml, and ≥ 4.0 mg/ml. Results. 943 PE protocol CT exams were reviewed. 410 subjectshad D-dimer values drawn before their CT exams; 30 (7.3% of thesewere positive for acute PE. As D-dimer values became increasingly elevated, the prevalence of acute PE increased accordingly. In particular, D-dimer elevation ≥4.0 mg/ml was almost 94% specific for acute PE by CT criteria. Conclusion. Increased elevation of plasma D-dimer is associated with increased prevalence of acute PE in low-to-intermediate risk patients.

  8. Early Diagnosis of Acute Coronary Syndrome with Sensitive Troponin I and Ischemia Modified Albumin

    Directory of Open Access Journals (Sweden)

    MA Takhshid

    2010-12-01

    Full Text Available Background: In this study we compared the diagnostic performance ofserum ischemia modified albumin (IMA and sensitive cardiac troponin I (cTnIassay for the detection of acute coronary syndrome (ACS in patients presentingto the emergency department (ED with acute chest pain.Methods: A prospective study was conducted on 123 patients presenting tothe ED within three hours of acute chest pain. A 12-lead ECG was recorded andIMA and cTnI were measured on arrival at the ED. After diagnostic testing, thepatients were classified as either ACS (n=70 or non- ACS (n= 53. The resultsof IMA, ECG, and cTnI, alone and in combination, were correlated with finaldiagnoses.Results: IMA showed higher sensitivity (84% and negative predictivevalue (NPV, 88% compared to cTnI (sensitivity 42%, NPV 66% and ECG(sensitivity 58%, NPV 74%. Combined use of IMA, cTnI and ECG significantlyimproved the sensitivity (96%, P<0.05 and NPV (96% of IMA. The diagnosticperformance of IMA was similar in the case of non-ST-segment-elevation ACS(sensitivity 80%, NPV 80%. The sensitivity and specificity of IMA for diagnosisof acute myocardial infarction (AMI were 88% and 48%, respectively.Conclusion: Measuring IMA at the time of ED admission improves the earlydiagnosis of ACS and non-ST-segment-elevation ACS in patients with acute chestpain. However, the test is not an effective tool for diagnosis of AMI inpatients with chest pain presenting to ED.

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

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

    DEFF Research Database (Denmark)

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

    2012-01-01

    The complement system is an important mediator of inflammation, which plays a pivotal role in atherosclerosis and acute myocardial infarction (AMI). Animal studies suggest that activation of the complement cascade resulting in the formation of soluble membrane attack complex (sMAC), contributes...... to both atherosclerosis and plaque rupture and may be the direct cause of tissue damage related to ischemia/reperfusion injury. However clinical data of sMAC during an AMI is sparse. Accordingly the aim was to investigate the prognostic role of sMAC in patients with ST-segment elevation myocardial...

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

    Directory of Open Access Journals (Sweden)

    Ruben N Eppinga

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

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

    Science.gov (United States)

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

    2016-01-01

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

  13. Early reperfusion strategy for acute myocardial infarction:a need for clinical implementation

    Institute of Scientific and Technical Information of China (English)

    Yan ZHANG; Yong HUO

    2011-01-01

    Reperfusion is the key strategy in acute ST-segment elevation myocardial infarction (STEMI) care,and it is time-dependent.Shortening the time from symptom to reperfusion and choosing the optimal reperfusion strategy for STEMI patients are great challenges in practice.We need to improve upon the problems of low reperfusion rate,non-standardized treatment,and economic burden in STEMI care.This article briefly reviews the current status of reperfusion strategy in STEMI care,and also introduces what we will do to bridge the gap between the guidelines and implementation in the clinical setting through the upcoming China STEMI early reperfusion program.

  14. Clinical significance of serum triglyceride elevation at early stage of acute biliary pancreatitis

    OpenAIRE

    Cheng, Long; Luo, Zhulin; Xiang, Ke; Ren, Jiandong; Huang, Zhu; Tang, Lijun; Tian, Fuzhou

    2015-01-01

    Background Pancreatitis induced by hypertriglyceridemia (HTG) has gained much attention. However, very limited numbers of studies have focused on the clinical significance of TG elevation in non-HTG induced pancreatitis, such as acute biliary pancreatitis (ABP). This study aimed to study the clinical significances of triglyceride (TG) elevation in patients with ABP. Methods We retrospectively analyzed a total of 426 ABP cases in our research center. According to the highest TG level within 72...

  15. BLOOD LEVELS OF INTERLEUKIN-6 AND INTERLEUKIN-10 IN SERUM AND BIOMARKERS OF ACUTE KIDNEY INJURY IN ACUTE CORONARY SYNDROME

    Directory of Open Access Journals (Sweden)

    M. A. Shalenkova

    2015-01-01

    Full Text Available Certain correlations between changes of cytokine levels and kidney dysfunction, as well as their prognostic significance for development of acute kidney injury (АКI in different clinical forms of ischemic heart disease (IHD seem to be worth of further studies. The levels of IL-6 and IL-10 and their correlation with serum creatinine (sCr and lipocalin levels in urine (u-NGAL were studied in 98 IHD patients, of them 93 presented with acute coronary syndrome (ACS and 5, with stable angina pectoris. ACS patients were found to have increased levels of IL-6, IL-10, sCr, u-NGAL. IL-6 and IL-10 contents proved to be increased in cases of non-ST-segment elevation ACS (NSTE-ACS, and during AKI development. According to serum creatinin levels, AKI was more frequently revealed in patients with NSTE-ACS. Urinary NGAL levels were found to be higher in ACS with ST segment elevation

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

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  17. Effect of continuous positive airway pressure ventilation on nocturnal ST-segment changes in patients with sleep-disordered breathing

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective To determine whether sleep-disordered breathing (SDB) may lead to nocturnal myocardial ischemia and whether the severity of this ischemia may be relieved by nasal continuous positive airway pressure (CPAP). Methods Overnight polysomnogram examination and simultaneous 3-channel Holter monitoring were performed on 76 patients with moderate to severe SDB and no history of coronary heart disease. All the cases were treated with CPAP for one night. ST depression was defined as a ST segment decrease of more than 1 mm from baseline and lasting 1 min or more. The total duration (minutes) of ST depression was indexed to the total sleep time (minutes per hour of sleep). Results Twenty-eight patients (37%) showed ST segment depression during their sleep. Before CPAP treatment, the respiratory disturbance index (RDI) and arousal index were significantly higher during periods of ST depression than when ST segments were isoelectric, whereas no significant difference was found in blood oxygen saturation (SaO2). After the CPAP treatment of patients with ST depression, the duration of ST depression was significantly reduced from 36.8±18.9 to 11.4±13.2 min/h (P<0.05). ST depression-related indexes, including RDI, arousal index and the percentage of sleep time spent at SaO2 below 90% (TS90/ TST), were all significantly decreased, with RDI from 63.4±23.8 to 8.1±6.6 /h, arousal index from 51.2±18.9 to 9.6±5.4 /h, and TS90/ TST from 50.6±21.4 to 12.9±14.7% (P<0.05). Conclusion ST-segment depression is rather common in patients with moderate to severe SDB, and CPAP treatment can significantly reduce the duration of ST depression. ST depression in these patients may reflect the myocardial ischemia that really exists and the non-ischemic changes associated with recurrent SDB.

  18. Early ambulance initiation versus in-hospital initiation of high dose clopidogrel in ST-segment elevation myocardial infarction

    NARCIS (Netherlands)

    Postma, S.; Dambrink, J.H.; Ottervanger, J.P.; Gosselink, A.T.M.; Koopmans, P.C.; Berg, J.M. van den; Suryapranata, H.; Hof, A.W. van 't

    2014-01-01

    Pre-hospital infarct diagnosis gives the opportunity to start anti-platelet and anti-thrombotic agents before arrival at the PCI centre. However, more evidence is necessary to demonstrate whether high dose (HD) clopidogrel (600 mg) administered in the ambulance is associated with improved initial pa

  19. Chronic Metformin Treatment is Associated with Reduced Myocardial Infarct Size in Diabetic Patients with ST-segment Elevation Myocardial Infarction

    NARCIS (Netherlands)

    Lexis, Chris P. H.; Wieringa, Wouter G.; Hiemstra, Bart; van Deursen, Vincent M.; Lipsic, Erik; van der Harst, Pim; van Veldhuisen, Dirk J.; van der Horst, Iwan C. C.

    2014-01-01

    Increased myocardial infarct (MI) size is associated with higher risk of developing left ventricular dysfunction, heart failure and mortality. Experimental studies have suggested that metformin treatment reduces MI size after induced ischaemia but human data is lacking. We aimed to investigate the e

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

    International Nuclear Information System (INIS)

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

  1. Acute Cholecystitis with Significantly Elevated Levels of Serum Carbohydrate Antigen 19-9

    Directory of Open Access Journals (Sweden)

    Shuji Akimoto

    2016-08-01

    Full Text Available Serum carbohydrate antigen 19-9 (CA 19-9, a marker of malignant tumors, is generally slightly elevated in benign conditions. We report a case of acute cholecystitis with a significantly elevated level of serum CA 19-9 based on positron emission tomography (PET-computed tomography (CT findings. A 65-year-old woman presented with abdominal pain and fever. A CT image revealed an enlarged gallbladder without tumor shadows. The C-reactive protein (CRP level was elevated to 7.66 mg/dl. Moreover, the serum CA 19-9 level was significantly elevated to 19,392 U/ml. We started antibiotic treatment, because we suspected acute cholecystitis, but still, we could not ignore the possible presence of malignant tumors. After 11 days of antibiotic treatment, serum CRP and CA 19-9 levels decreased to 0.11 mg/dl and 1,049 U/ml, respectively. There was an accumulation of fluorine 18-labeled fluorodeoxyglucose (maximum standardized uptake value, 9.3 without tumor shadows in the liver, near the gallbladder, on the PET-CT examination. We considered the possibility that the inflammation had spread from the gallbladder to the liver, made a diagnosis of acute cholecystitis, and performed a cholecystectomy 33 days after treatment initiation. The serum CA 19-9 level decreased to 45 U/ml after the surgery. One year after the surgery, the patient was alive, and the serum CA 19-9 level was 34 U/ml. Acute cholecystitis with a significantly high elevation of the serum CA 19-9 level is rare. In such cases, it is important to confirm the change in the serum CA 19-9 level over time after antibiotic treatment and perform imaging studies to distinguish between inflammation and malignancy.

  2. A Model for Predicting Persistent Elevation of Factor VIII among Patients with Acute Ischemic Stroke

    Science.gov (United States)

    Samai, Alyana A.; Boehme, Amelia K.; Shaban, Amir; George, Alexander J.; Dowell, Lauren; Monlezun, Dominique J.; Leissinger, Cindy; Schluter, Laurie; El Khoury, Ramy; Martin-Schild, Sheryl

    2016-01-01

    Background and Purpose Elevated levels of coagulation factor VIII (FVIII) may persist independent of the acute-phase response; however, this relationship has not been investigated relative to acute ischemic stroke (AIS). We examined the frequency and predictors of persistently elevated FVIII in AIS patients. Methods AIS patients admitted between July 2008 and May 2014 with elevated baseline FVIII levels and repeat FVIII levels drawn for more than 7 days postdischarge were included. The patients were dichotomized by repeat FVIII level for univariate analysis at 150% and 200% activity thresholds. An adjusted model was developed to predict the likelihood of persistently elevated FVIII levels. Results Among 1616 AIS cases, 98 patients with elevated baseline FVIII had repeat FVIII levels. Persistent FVIII elevation was found in more than 75% of patients. At the 150% threshold, the prediction score ranged from 0 to 7 and included black race, female sex, prior stroke, hyperlipidemia, smoking, baseline FVIII > 200%, and baseline von Willebrand factor (vWF) level greater than 200%. At the 200% threshold, the prediction score ranged from 0–5 and included female sex, prior stroke, diabetes mellitus, baseline FVIII level greater 200%, and baseline vWF level greater than 200%. For each 1-point increase in score, the odds of persistent FVIII at both the 150% threshold (odds ratio [OR] = 10.4, 95% confidence interval [CI] 1.63–66.9, P = .0134) and 200% threshold (OR = 10.2, 95% CI 1.82–57.5, P = .0083) increased 10 times. Conclusion Because an elevated FVIII level confers increased stroke risk, our model for anticipating a persistently elevated FVIII level may identify patients at high risk for recurrent stroke. FVIII may be a target for secondary stroke prevention. PMID:26777556

  3. [Exercise-induced ST segment shift in vasospastic angina with special reference to comparisons between treadmill and bicycle ergometer exercise testings].

    Science.gov (United States)

    Kasai, A; Yamakado, T; Masuda, T; Aoki, T; Futagami, Y; Hamada, M; Nakano, T

    1991-01-01

    To assess the difference between cardiovascular responses to treadmill exercise (TM) and those to bicycle ergometer exercise (EM) in provoking coronary spasm, we compared the ST segment shifts (elevation or depression) during TM and EM in 67 patients with vasospastic angina. Coronary artery spasm was demonstrated on angiography. Both TM and EM were performed on the same day during a medication-free period. For both tests, multistage, symptom-limited exercise protocols were used; EM in the morning and TM in the afternoon. The results obtained were as follows: 1. Rate-pressure products at peak exercise during TM and EM were similar. Systolic blood pressure levels at peak exercise were higher during EM than during TM (p < 0.01). The patients' heart rates at peak exercise were higher during TM than during EM (p < 0.01). Diastolic blood pressure levels at peak exercise were higher during EM than during TM (p < 0.05). 2. Exercise-induced ST elevation occurred more frequently with TM than with EM (19% vs 9%, p < 0.05). 3. Exercise-induced ST depression was provided in 27 patients during TM and in 13 during EM (40% vs 19%, p < 0.01). Among 45 patients without significant lesions, ST depression occurred in 19 during TM, but in only 7 during EM (42% vs 16%, p < 0.01). In conclusion, coronary spasm seemed to occur more frequently with TM than with EM. The mechanism causing such difference remains to be elucidated, however, we speculate that the difference between TM and EM as to enhanced autonomous nervous system activity and coronary perfusion exercise may be related to the difference in the incidence of coronary spasm. PMID:1841908

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

    Institute of Scientific and Technical Information of China (English)

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

    2012-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    SHEN Wei-feng

    2006-01-01

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

  6. Association between Periodontal Disease and Elevated C-reactive Protein in Acute Myocardial Infarction Patients

    OpenAIRE

    G. Radafshar; B. Shad; M. Mirfeizi

    2006-01-01

    Statement of problem: Periodontal disease (PD) has been linked to adverse cardiovascular events by unknown mechanisms. C-reactive protein (CRP) is a prognostic marker for cardiovascular disease, with reported elevated serum levels during PD.Purpose: The aim of the present study was to evaluate the association between PD and higher CRP levels in the serum of acute myocardial infarction (AMI) patients.Materials and Methods: In this cross-sectional study, periodontal examinations and CRP serum l...

  7. The effect of delayed PCI on NT-proBNP and clinical significance in patients with acute ST-segment elevation myocardial infarction%延迟PCI对急性ST段抬高型心肌梗死患者血浆N-末端脑钠素原影响及临床意义

    Institute of Scientific and Technical Information of China (English)

    陈子国; 黄琦磊; 王光友

    2011-01-01

    目的 研究急性ST段抬高型心肌梗死患者延迟PCI术前及术后血浆N-末端脑钠素原水平变化,探讨延迟PCI对心功能的影响.方法 选择住院治疗的急性ST段抬高型心肌梗死患者80例,根据是否行延迟PCI术分为两组,两组患者均于心梗后1周、术前1天、术后3天、6个月检测血浆脑钠素N端前体肽水平的变化,分别于心梗后1周、术前1天、术后3天、6个月做心脏超声检查,测定左室射血分数及左室舒张末期容积,对比PCI组和非PCI组两组患者心脏超声和N-末端脑钠素原的动态变化.结果 PCI组术后3天脑钠素N端前体肽水平明显下降(P<0.01);6个月后 PCI组的N-末端脑钠素原明显低于非PCI组(P<0.01),PCI组的左室射血分数值高于非PCI组(P<0.05),非PCI组左室舒张末期容积明显大于PCI组(P<0.05).结论 延迟PCI能改善急性心肌梗死患者的心功能.

  8. 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

    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...... ACS is the largest randomized clinical trial to date focusing exclusively on medically managed NSTE ACS patients and will provide important information regarding the optimal approach to oral antiplatelet therapy for this high-risk, understudied population....

  9. Clinical features and coronary lesion characteristics in elderly women with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention%老年女性急性ST段抬高型心肌梗死患者行急诊PCI的临床特点及冠状动脉病变特点分析

    Institute of Scientific and Technical Information of China (English)

    周鹤; 王效增; 王耿; 梁振洋; 韩雅玲

    2016-01-01

    目的 探讨急性ST段抬高型心肌梗死(STEMI)行急诊经皮冠状动脉介入治疗(PCI)的老年女性患者临床及冠脉病变特点.方法 回顾性分析了2006年至2012年我院连续收入的首次诊断为STEMI并接受急诊PCI术的女性患者366例.根据年龄分为两组:老年组(≥65岁;n=211)和非老年组(<65岁;n=155).分析两组患者临床及冠脉病变特点.结果 与非老年组患者相比,老年组中糖尿病发生率和空腹血糖值均显著较高(P<0.05),吸烟者的比例和肾小球滤过率显著较低(P< 0.05),老年组患者冠脉三支病变率显著增加(P<0.05),靶血管为左前降支(left anterior descending branch,LAD)的概率显著降低(P<0.05).老年组和非老年组患者接受急诊PCI的成功率分别为98.58%和98.87%.结论 不同年龄阶段的女性STEMI患者具有不同的危险因素特点,老年女性STEMI患者较非老年女性患者,冠状动脉病变更为复杂.

  10. 急性ST段抬高型心肌梗死择期PCI新定义——及时溶解血栓开通冠脉%Novel definition of selective PCI in acute ST-segment elevation myocardial infarction: prompt dissolution of thrombi, the earliest opening of coronary artery

    Institute of Scientific and Technical Information of China (English)

    张步春

    2010-01-01

    近年来国外一些研究结果和最新荟萃分析提示,急性心肌梗死溶栓成功后3~24 h内择期PCI治疗对于改善左室重塑,改善顿抑或冬眠心肌的血流,防止梗死区域的扩展及延伸,缩小梗死面积起着重要作用.该文对近年来临床研究和治疗指南作一回顾,进一步说明急性心肌梗死溶栓成功后择期PCI的临床价值.

  11. 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

    OBJECTIVES: The purpose of this study was to investigate whether FX06 would limit infarct size when given as an adjunct to percutaneous coronary intervention. BACKGROUND: FX06, a naturally occurring peptide derived from human fibrin, has been shown to reduce myocardial infarct size in animal mode...

  12. The risk factors and prevention of cardiovascular disease: the importance of electrocardiogram in the diagnosis and treatment of acute coronary syndrome.

    Science.gov (United States)

    Rosiek, Anna; Leksowski, Krzysztof

    2016-01-01

    Acute coronary syndrome is a leading cause of emergency medical treatment and hospitalization in Poland. High-speed electrocardiogram (ECG) has shown good accuracy of the initial diagnosis and of the final diagnosis in treated cardiac patients. Initial diagnosis and definitive diagnosis were analyzed statistically (Pattention to the need for early diagnosis and ECG analysis (at the stage of prevention). This article presents the inclusion of ECG in the prevention process and shows that it allows for early detection of cardiovascular diseases. In Poland, ST-segment elevation myocardial infarction patients are identified in the ambulance that reduces time to door-to-balloon. PMID:27540297

  13. Inhibition of platelet aggregation by AZD6140, a reversible oral P2Y12 receptor antagonist, compared with clopidogrel in patients with acute coronary syndromes

    DEFF Research Database (Denmark)

    Storey, Robert F; Husted, Steen; Harrington, Robert A;

    2007-01-01

    OBJECTIVES: In a substudy of DISPERSE (Dose confIrmation Study assessing anti-Platelet Effects of AZD6140 vs. clopidogRel in non-ST-segment Elevation myocardial infarction)-2, we compared the antiplatelet effects of AZD6140 and clopidogrel and assessed the effects of AZD6140 in clopidogrel......-pretreated patients. BACKGROUND: Clopidogrel, in combination with aspirin, reduces cardiovascular events in patients with acute coronary syndromes (ACS). However, patients with poor inhibition of platelet aggregation with clopidogrel may be less well protected. AZD6140 is a reversible oral P2Y(12) receptor antagonist...

  14. The risk factors and prevention of cardiovascular disease: the importance of electrocardiogram in the diagnosis and treatment of acute coronary syndrome

    Science.gov (United States)

    Rosiek, Anna; Leksowski, Krzysztof

    2016-01-01

    Acute coronary syndrome is a leading cause of emergency medical treatment and hospitalization in Poland. High-speed electrocardiogram (ECG) has shown good accuracy of the initial diagnosis and of the final diagnosis in treated cardiac patients. Initial diagnosis and definitive diagnosis were analyzed statistically (Particle presents the inclusion of ECG in the prevention process and shows that it allows for early detection of cardiovascular diseases. In Poland, ST-segment elevation myocardial infarction patients are identified in the ambulance that reduces time to door-to-balloon. PMID:27540297

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

    Directory of Open Access Journals (Sweden)

    Knežević Božidarka

    2008-01-01

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

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

    International Nuclear Information System (INIS)

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

  17. Novel Antiplatelet Agent Use for Acute Coronary Syndrome in the Emergency Department: A Review

    Directory of Open Access Journals (Sweden)

    M. Curial

    2013-01-01

    Full Text Available Background. Acute Coronary Syndrome (ACS is a clinical condition encompassing ST Segment Elevation Myocardial Infarction (STEMI, Non-ST Segment Elevation Myocardial Infarction (NSTEMI, and Unstable Angina (UA and is characterized by ruptured coronary plaque, ischemic stress, and/or myocardial injury. Emergency department (ED physicians are on the front lines of ACS management. The role of new antiplatelet agents ticagrelor and prasugrel in acute ED management of ACS has not yet been defined. Objective. To critically review clinical trials using ticagrelor and prasugrel in the treatment of ACS and inform practitioners of their potential utility in treating ACS in the ED. Results. Trials on the efficacy of ticagrelor and prasugrel achieve statistical significance in decreasing composite endpoints in select patient populations. Conclusion. The use of ticagrelor and prasugrel as first line ED treatment of ACS is not well established. Current evidence supports the use of several agents with the final decision based on treatment protocols conjointly developed between cardiology and emergency medicine (EM. Further clinical trials involving head-to-head trials or comparisons of drug-based strategies are required to show superiority in reducing cardiac endpoints with regard to ED initiation of treatment.

  18. Eptifibatide: The evidence for its role in the management of acute coronary syndromes

    Directory of Open Access Journals (Sweden)

    Ibrahim Shah

    2009-06-01

    Full Text Available Ibrahim Shah, Shakeel O Khan, Surender Malhotra, Tim FischellBorgess Heart institute, Kalamazoo, Michigan, USAIntroduction: Acute coronary syndromes and non-Q-wave myocardial infarction are often initiated by platelet activation. Eptifibatide is a cyclic heptapeptide and is the third inhibitor of glycoprotein (Gp IIb/IIIa that has found broad acceptance after the specific antibody abciximab and the nonpeptide tirofiban entered the global market. Gp IIb/IIIa inhibitors act by inhibiting the final common pathway of platelet aggregation, and play an important role in the management of acute coronary syndromes.Aims: This review assesses the evidence for therapeutic value of eptifibatide as a Gp IIb/IIIa inhibitor in patients with acute coronary syndromes.Evidence review: Several large, randomized controlled trials show that eptifibatide as adjunctive therapy to standard care in patients with non-ST segment elevation acute coronary syndrome is associated with a significant reduction in the incidence of death or myocardial infarction. Data are limited regarding the use of eptifibatide in patients with ST segment elevation myocardial infarction. Cost-effectiveness analysis indicates that eptifibatide is associated with a favorable cost-effectiveness ratio relative to standard care. According to US cost-effectiveness analysis about 70% of the acquisition costs of eptifibatide are offset by the reduced medical resource consumption during the first year. Eptifibatide was well tolerated in most of the trials. Bleeding is the most commonly reported adverse event, with most major bleeding episodes occurring at the vascular access site. Major intracranial bleeds, stroke, or profound thrombocytopenia rarely occurred during eptifibatide treatment.Place in therapy: Eptifibatide has gained widespread acceptance as an adjunct to standard anticoagulation therapy in patients with acute coronary syndromes, and may be particularly useful in the management of patients

  19. Distinguishing the right coronary artery from the left circumflex coronary artery as the infarct-related artery in patients undergoing primary percutaneous coronary intervention for acute inferior myocardial infarction

    NARCIS (Netherlands)

    N.J. Verouden; K. Barwari; K.T. Koch; J.P. Henriques; J. Baan; R.J. van der Schaaf; M.M. Vis; R.B. van den Brink; J.J. Piek; J.G. Tijssen; R.J. de Winter

    2009-01-01

    Aim of this study was to investigate the diagnostic accuracy of the conventional electrocardiogram (ECG) algorithm [ST-segment elevation (STE) in lead III exceeding that in lead II combined with ST-segment depression in lead I or aVL] for identification of the infarct-related artery (IRA) in a large

  20. Acute nitric oxide synthase inhibition and endothelin-1-dependent arterial pressure elevation

    Directory of Open Access Journals (Sweden)

    Robert eRapoport

    2014-04-01

    Full Text Available Key evidence that endogenous nitric oxide (NO inhibits the continuous, endothelin (ET-1-mediated drive to elevate arterial pressure includes demonstrations that ET-1 mediates a significant component of the pressure elevated by acute exposure to NO synthase (NOS inhibitors. This review examines the characteristics of this pressure elevation in order to elucidate potential mechanisms associated with the negative regulation of ET-1 by NO and, thereby, provide potential insight into the vascular pathophysiology underlying NO dysregulation. We surmise that the magnitude of the ET-1-dependent component of the NOS inhibitor-elevated pressure is 1 independent of underlying arterial pressure and other pressor pathways activated by the NOS inhibitors and 2 dependent on relatively higher NOS inhibitor dose, release of stored and de novo synthesized ET-1, and ETA receptor-mediated increased vascular resistance. Major implications of these conclusions include: 1 the marked variation of the ET-1-dependent component, i.e., from 0-100% of the pressure elevation, reflects the NO-ET-1 regulatory pathway. Thus, NOS inhibitor-mediated, ET-1-dependent pressure elevation in vascular pathophysiologies is an indicator of the level of compromised/enhanced function of this pathway; 2 NO is a more potent inhibitor of ET-1-mediated elevated arterial pressure than other pressor pathways, due in part to inhibition of intravascular pressure-independent release of ET-1. Thus, the ET-1-dependent component of pressure elevation in vascular pathophysiologies associated with NO dysregulation is of greater magnitude at higher levels of compromised NO.

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

    Directory of Open Access Journals (Sweden)

    Petrović Milovan

    2006-01-01

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

  2. Scorpion envenomation-induced acute thrombotic inferior myocardial infarction.

    Science.gov (United States)

    Baykan, Ahmet Oytun; Gür, Mustafa; Acele, Armağan; Şeker, Taner; Çaylı, Murat

    2016-01-01

    The occurrence of a serious cardiac emergency following scorpion envenomation has rarely been reported and, when so, mostly presented as non-ST segment elevation myocardial infarction, cardiogenic shock, or myocarditis. Possible mechanisms include imbalance in blood pressure and coronary vasospasm caused by the combination of sympathetic excitation, scorpion venom-induced release of catecholamines, and the direct effect of the toxin on the myocardium. We report a case of a 55-year-old man who presented with acute inferior wall myocardial infarction (MI) within 2 h of being stung by a scorpion. Coronary angiogram revealed total thrombotic occlusion of the left circumflex artery, which was treated successfully with glycoprotein IIb/IIIa inhibitor, thrombus aspiration, antivenom serum, and supportive therapy. Therefore, life-threatening MI can complicate the clinical course during some types of scorpion envenomation and should be managed as an acute coronary syndrome. PMID:26875137

  3. Elevated troponin T after acute ischemic stroke: Association with severity and location of infarction.

    Directory of Open Access Journals (Sweden)

    Siamak Abdi

    2015-03-01

    Full Text Available Serum troponin elevation, characteristic of ischemic myocardial injury, has been observed in some acute ischemic stroke (AIS patients. Its cause and significance are still controversial. The purpose of this study is to find determinants of troponin elevation and its relationship with stroke severity and location.Between January 2013 and August 2013, 114 consecutive AIS patients confirmed by diffusion-weighted magnetic resonance imaging were recruited in this study. Serum troponin T level was measured as part of routine laboratory testing on admission. Ten lead standard electrocardiogram (ECG was performed and stoke severity was assessed based on National Institutes of Health Stroke Scale (NIHSS.Troponin T was elevated in 20 (17.6% of 114 patients. Patients with elevated troponin were more likely to have higher age, higher serum creatinine and ischemic ECG changes. Troponin levels were higher in patients with more severe stroke measured by NIHSS [7.96 (6.49-9.78 vs. 13.59 (10.28-18.00]. There was no association between troponin and locations of stroke and atrial fibrillation. There were 6 (5% patients with elevated troponin in the presence of normal creatinine and ECG.Stroke severity, not its location, was associated with higher troponin levels. Abnormal troponin levels are more likely, but not exclusively, to be due to cardiac and renal causes than cerebral ones.

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

    Science.gov (United States)

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

    2010-07-01

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

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

    DEFF Research Database (Denmark)

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

    2008-01-01

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

  6. Association of cardiovascular risk factors with the different presentations of acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    Evelise Helena Fadini Reis Brunori

    2014-08-01

    Full Text Available OBJECTIVE: to identify the relationship between different presentations of acute coronary syndrome and cardiovascular risk factors among hospitalized individuals.METHOD: cross-sectional study performed in a teaching hospital in São Paulo, in the State of São Paulo (SP. Socio-demographic, clinical and anthropometric data of 150 individuals hospitalized due to acute coronary syndrome were collected through interviews and review of clinical charts. Association between these data and the presentation of the syndrome were investigated.RESULTS: there was a predominance of ST segment elevation acute myocardial infarction. There was significant association of systemic hypertension with unstable angina and high values of low density lipoprotein with infarction, without influence from socio-demographic characteristics.CONCLUSION: arterial hypertension and high levels of low-density lipoprotein were associated with different presentations of coronary syndrome. The results can provide support for health professionals for secondary prevention programs aimed at behavioural changing.

  7. Outcomes of patients calling emergency medical services for suspected acute cardiovascular disease

    DEFF Research Database (Denmark)

    Schoos, Mikkel Malby; Sejersten, Maria; Baber, Usman;

    2015-01-01

    .4%, respectively. Stroke, acute heart failure, and ST-segment elevation myocardial infarction (STEMI) carried a 25- to 50-fold adjusted mortality hazard during the first 4 days. In patients with suspected STEMI, 90.5% had an acute angiography performed. Nontransferred, nonreperfused patients with STEMI (9......Adequate health care is increasingly dependent on prehospital systems and cardiovascular (CV) disease remains the most common cause for hospital admission. However the prevalence of CV dispatches of emergency medical services (EMS) is not well reported and survival data described in clinical trials...... and registries are subject to selection biases. We aimed to describe the prevalence and prognosis of acute CV disease and the effect of invasive treatment, in an unselected and consecutive prehospital cohort of 3,410 patients calling the national emergency telephone number from 2005 to 2008 with follow...

  8. Prognostic value of circulating catestatin levels for in-hospital heart failure in patients with acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    冀磊

    2013-01-01

    Objective To determine whether circulating level of catestatin(CST) could provide prognostic information independently of conventional risk markers for the development of in-hospital heart failure in patients with ST-segment elevation myocardial infarction(STEMI).

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

    Science.gov (United States)

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

    2015-07-01

    Oxidative stress affects clinical outcome in patients with ST-elevation acute coronary syndrome (STE-ACS). Although high-density lipoprotein (HDL) particles are generally considered protective, deleterious properties of HDL have been observed in patients with acute myocardial infarction. Here, we analysed the association between pro-oxidant HDL and all-cause mortality in STE-ACS patients. We determined the antioxidant function of HDL in 247 prospectively enrolled patients undergoing primary percutane