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Seker, Onur Osman, Idris Bugra Cerik, Metin Coksevim, Mustafa Yenercag y Korhan Soylu. "Effectiveness of Different P2Y12 Inhibitors on Coronary Flow in Patients with ST-Elevation Myocardial Infarction". Journal Of Cardiovascular Emergencies 6, n.º 4 (1 de diciembre de 2020): 91–97. http://dx.doi.org/10.2478/jce-2020-0018.
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Abstract Background: ST-segment elevation myocardial infarction (STEMI) is a clinical syndrome with high mortality. The main purpose of STEMI treatment is to achieve optimal revascularization for tissue perfusion. Besides the innovations in revascularization strategies, developments in antithrombotic therapy resulted in a significant reduction in STEMI-related mortality. Reperfusion can be demonstrated by resolution of ST-segment elevation (STR), TIMI frame count (TFC), and myocardial blush grade (MBG). Aim of the study: In our study, we investigated the effects of P2Y12 inhibitors clopidogrel, prasugrel, and ticagrelor on reperfusion parameters such as TFC, MBG, and STR, after primary percutaneous coronary intervention (pPCI) in STEMI. Material and Methods: The study was a retrospective analysis of STEMI patients who underwent successful pPCI. A total of 120 patients were included in the study as 3 equal groups according to the type of P2Y12 inhibitor administered in loading dose in the acute phase, and reperfusion parameters were compared between the groups. Results: There was no statistically significant difference between the groups in terms of baseline demographic, clinical, and angiographic parameters. Evaluation of reperfusion parameters indicated that STR, MBG, angina relief after pPCI and corrected TFC (cTFC) were significantly different between the groups (p <0.05). In post-hoc analysis, the percentage of change in STR, MBG, angina relief after pPCI, and cTFC was significantly higher in the prasugrel group (p <0.017). Conclusion: In STEMI patients undergoing pPCI, the analysis of tissue level reperfusion parameters indicates a superior effect of prasugrel compared with other P2Y12 inhibitors used to achieve reperfusion.
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Seker, Onur Osman, Idris Bugra Cerik, Metin Coksevim, Mustafa Yenercag y Korhan Soylu. "Effectiveness of Different P2Y12 Inhibitors on Coronary Flow in Patients with ST-Elevation Myocardial Infarction". Journal Of Cardiovascular Emergencies 6, n.º 4 (1 de diciembre de 2020): 91–97. http://dx.doi.org/10.2478/jce-2020-0018.
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AbstractBackground: ST-segment elevation myocardial infarction (STEMI) is a clinical syndrome with high mortality. The main purpose of STEMI treatment is to achieve optimal revascularization for tissue perfusion. Besides the innovations in revascularization strategies, developments in antithrombotic therapy resulted in a significant reduction in STEMI-related mortality. Reperfusion can be demonstrated by resolution of ST-segment elevation (STR), TIMI frame count (TFC), and myocardial blush grade (MBG). Aim of the study: In our study, we investigated the effects of P2Y12 inhibitors clopidogrel, prasugrel, and ticagrelor on reperfusion parameters such as TFC, MBG, and STR, after primary percutaneous coronary intervention (pPCI) in STEMI.Material and Methods: The study was a retrospective analysis of STEMI patients who underwent successful pPCI. A total of 120 patients were included in the study as 3 equal groups according to the type of P2Y12 inhibitor administered in loading dose in the acute phase, and reperfusion parameters were compared between the groups.Results: There was no statistically significant difference between the groups in terms of baseline demographic, clinical, and angiographic parameters. Evaluation of reperfusion parameters indicated that STR, MBG, angina relief after pPCI and corrected TFC (cTFC) were significantly different between the groups (p <0.05). In post-hoc analysis, the percentage of change in STR, MBG, angina relief after pPCI, and cTFC was significantly higher in the prasugrel group (p <0.017).Conclusion: In STEMI patients undergoing pPCI, the analysis of tissue level reperfusion parameters indicates a superior effect of prasugrel compared with other P2Y12 inhibitors used to achieve reperfusion.
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Kireyev, Dmitriy, Huay Cheem Tan y Kian Keong Poh. "Management of Acute ST-Elevation Myocardial Infarction: Reperfusion Options". Annals of the Academy of Medicine, Singapore 39, n.º 12 (15 de diciembre de 2010): 927–33. http://dx.doi.org/10.47102/annals-acadmedsg.v39n12p927.
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Primary percutaneous coronary intervention and thrombolysis remain therapies of choice for patients presenting with ST-segment elevation myocardial infarction (STEMI). Clinical outcome in the management of acute STEMI is dependent on myocardial reperfusion time and reperfusion strategies. Optimisation of these strategies should take into consideration logistical limitations of the local medical systems and the various patient profiles. We review the reperfusion strategies and its history in Singapore, comparing its clinical application with that in some developed Western countries. Key words: Acute Myocardial Infarction, Primary Percutaneous Coronary Intervention, ST segment Elevation Myocardial Infarction, Thrombolysis
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Vlachojannis, Georgios J., Bimmer E. Claessen y George D. Dangas. "Early Stent Thrombosis after Percutaneous Coronary Intervention for Acute Myocardial Infarction". Interventional Cardiology Review 7, n.º 1 (2012): 33. http://dx.doi.org/10.15420/icr.2012.7.1.33.
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Stent thrombosis (ST) is the most feared complication of coronary stent treatment because of its morbidity and mortality. Ongoing research is focusing on the frequency and the timing in various patient subsets as well as the factors associated with the occurrence of ST. The mechanism of ST is multifactorial, hence various procedure-, lesion- and patient-related factors have been associated with its occurrence. Beside these factors the role of adjunctive antithrombotic therapy remains unchallenged. Emerging data suggest that primary percutaneous coronary intervention for ST-elevation myocardial infarction (STEMI) can be a predictor of subsequent ST. As patients presenting with STEMI are at increased risk of ST, employment of the optimal pharmacological, procedure- and device-related prevention and treatment modalities are imperative.
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Kandan, Sri Raveen y Thomas W. Johnson. "Contemporary Antiplatelet Strategies in the Treatment of STEMI using Primary Percutaneous Coronary Intervention". Interventional Cardiology Review 10, n.º 1 (2015): 26. http://dx.doi.org/10.15420/icr.2015.10.1.26.
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Reperfusion therapy for patients presenting with an acute ST-segment elevation myocardial infarction (STEMI) involves primary percutaneous coronary intervention (PPCI) and concomitant oral antiplatelet and intravenous antithrombotic pharmacotherapy. There is a conflict between the desire to reduce the time between first medical contact and coronary re-canalisation and achieving effective platelet inhibition with oral antiplatelet agents. This review outlines the currently available antiplatelet treatments, and their place within the therapeutic timeline of a patient presenting with STEMI. Additionally, we focus on current challenges associated with effective antiplatelet treatment, including acute stent thrombosis (AST), the effect of morphine, platelet function assessment and concomitant anticoagulant therapy.
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Gilyarov, M. Yu, E. V. Konstantinova, M. R. Atabegashvili, T. D. Solntseva, D. A. Anichkov, А. N. Kostina, R. V. Polybin, A. E. Udovichenko y A. V. Svet. "Comorbidities and Percutaneous Coronary Intervention in Elderly Patients with Acute Coronary Syndrome". Rational Pharmacotherapy in Cardiology 17, n.º 2 (7 de mayo de 2021): 221–27. http://dx.doi.org/10.20996/1819-6446-2021-04-10.
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Aim. To assess comorbidities in elderly patients with acute coronary syndrome (ACS) and to analyze patient subgroups with different treatment strategies in the Regional Vascular Center (RVC).Material and methods. The prospective study included 205 patients with confirmed ACS 75 years and older, the mean age was 81±4.9 years, and 68% were women. ST segment elevation myocardial infarction (STEMI) was diagnosed in 46 (22.4 %) patients, non-ST segment elevation myocardial infarction (NSTEMI) was diagnosed in 159 (77,6 %) patients. The Charlson Comorbidity Index (CCI) was calculated in every patient. Early outcomes were defined as those assessed during hospital stay. Late outcomes were assessed at 6 months after the discharge using phone calls and/or clinic visits. All patients provided written informed consent.Results. Percutaneous coronary intervention (PCI) was performed in 42% of patients. In patients with STEMI and NSTEMI PCI was performed in 73% and 32%, respectively. Mean CCI score was 7.9 points: 7.6 points in men and 8.04 in women. Patients with STEMI had higher CCI score than NSTEMI patients (p<0.01): 8.1 points and 7.1 points, respectively. Patients who underwent PCI had lower CCI score (7.2 points) than patients in non-PCI group (8.2 points; p<0.05). Patients with STEMI in PCI and non-PCI groups had significant difference in CCI score (p<0.05): 7.4 and 8.4 points, respectively. Mean CCI score in patients who died in hospital was 8.5 while discharged patients had 7.6 points (p<0.01). In 6 months 13 patients (6.3%) died, their mean age was 84.9 years, mean CCI was 9 points, PCI was performed in 3 (23%) patients.Conclusions. Elderly patients with ACS had high comorbidity level assessed by CCI score. Higher CCI score was associated with PCI non-performance in elderly patients. Elderly patients with STEMI had higher CCI score than patients with NSTEMI which was significantly associated with PCI non-performance. Patients who died in hospital or in 6 months after the ACS onset had higher CCI score than other elderly patients with ACS.
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Thani, Khalid Bin, Fajer Al-Moosa, Eman Murad, Aisha Al-Moosa, Mohamed E. Alalawi y Hind Al-Sindi. "Stent Thrombosis after Rescue Percutaneous Coronary Intervention in Acute ST-Segment Elevation Myocardial Infarction". Open Cardiovascular Medicine Journal 9, n.º 1 (29 de diciembre de 2015): 127–32. http://dx.doi.org/10.2174/1874192401509010127.
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Main Problem:To determine the incidence of coronary stent thrombosis (ST) in patients with acute ST segment elevation myocardial infarction (STEMI) after rescue percutaneous coronary intervention (PCI). Methods:An observational study looking at the incidence of ST in a middle-eastern population. A total of 510 consecutive patients presented with ST-segment elevation myocardial infarction (STEMI) were enrolled and underwent thrombolytic therapy with a total follow-up period of 2 years. Study outcomes were ST, death, re-infarction or acute coronary syndrome requiring coronary angiography and PCI. Results:A total of 510 patients enrolled, all diagnosed with STEMI and underwent thrombolytic therapy. Only 100 subjects underwent rescue PCI with intra-coronary stenting, including 54 patients with drug-eluting stent (DES) and 46 patients with bare metal stent (BMS). During the study period and follow-up, the overall rate of ST was 13.7%, definite ST occurred in 6 patients (5.5%), probable ST in 8 patients (7.3%), and possible ST in one patient (0.9%), including 0.9% acute ST, 0.9% sub-acute ST, 2.8% late ST and 8.3% very late ST. Patients with ST were likely to have prior PCI (p=0.001), prior coronary artery bypass grafting (CABG) (p=0.002) and history of heart failure (p=0.04). Conclusion:ST is infrequent event with major consequences in patients presenting with STEMI in the first 2 years after stent implantation.
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Zeymer, Uwe, Peter Ludman, Nicolas Danchin, Petr Kala, Aldo P. Maggioni, Franz Weidinger, C. P. Gale et al. "The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry". European Heart Journal - Quality of Care and Clinical Outcomes 6, n.º 2 (30 de julio de 2019): 100–104. http://dx.doi.org/10.1093/ehjqcco/qcz042.
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Abstract Aims The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI. Methods and results Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission. Conclusion The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.
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Fallahzadeh, Aida, Ali Sheikhy, Afsaneh Aein, Mojtaba Salarifar, Hamidreza Pourhosseini, Hassan Aghajani, Mohammad Alidoosti, Saeed Sadeghian y Kaveh Hosseini. "Outcome of Percutaneous Coronary Intervention in Old Patients Presenting with Acute Coronary Syndrome". Archives of Iranian Medicine 25, n.º 8 (1 de agosto de 2022): 523–32. http://dx.doi.org/10.34172/aim.2022.84.
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Background: Octogenarians (age≥80 years) with coronary artery disease constitute a high-risk group and the elderly undergoing percutaneous coronary intervention (PCI) are at higher risk of adverse outcomes compared to young patients. In this study, we aimed to describe the outcomes of the elderly with acute coronary syndrome (ACS) who underwent PCI and also to identify the predictors of short-term major adverse cerebrocardiovascular events (MACCE) in octogenarians. Methods: In this registry-based cohort study, we reviewed the data of patients (aged≥65 years) who underwent PCI. Univariate Cox-regression model was used to assess the univariate effects of covariates on mortality and MACCE and multivariate Cox-regression analysis were used to discover MACCE predictors. Results: We reviewed the data of 3332 patients (2722 elderly [65 to 79 years], and 610 octogenarians [≥80 years]). The cumulative hazard of MACCE was significantly higher in the octogenarian group compared with the younger group (P<0.001). MACCE in octogenarians presenting with ST-elevation myocardial infarction (STEMI) was significantly higher than those with non-ST-elevation myocardial infarction/Unstable angina (NSTEMI/UA) (P<0.001); however, the cumulative hazard of mortality was not significantly different between the two groups (P=0.270). Successful PCI, left main stenosis and estimated glomerular filtration rate (eGFR) were independent predictors of MACCE in octogenarians with ACS. Conclusion: Octogenarians undergoing PCI had a higher rate of MACCE and mortality compared with a younger population. In octogenarians, MACCE in those with STEMI was significantly higher than those with NSTEMI/UA and the mortality trend was similar; however, the 1-year trend was in favor of the STEMI subgroup.
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Kedev, Sasko. "The Role of the Transradial Approach for Complex Coronary Interventions in Patients with Acute Coronary Syndrome". Interventional Cardiology Review 8, n.º 2 (2013): 81. http://dx.doi.org/10.15420/icr.2013.8.2.81.
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Despite advances in antithrombotic and antiplatelet therapy, bleeding complications remain an important cause of morbidity and mortality in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). A significant proportion of such bleedings are related to the access site, and adoption of transradial access (TRA) may reduce these complications. In patients with ST-segment elevation myocardial infarction (STEMI), TRA reduced cardiac mortality in comparison with the femoral approach (TFA). High-risk patients such as women, obese patients and elderly subjects who are at increased risk for vascular complications and bleeding, might particularly benefit from the TRA. However, specific radial expertise providing procedural time and a success rate comparable to those with the TFA are strongly recommended before using this technique in the emergency setting.
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Eliaz, Ran, Bethlehem Mengesha, Tal Ovdat, Zaza Iakobishvili, David Hasdai, Mark Kheifets, Robert Klempfner et al. "Ticagrelor versus Prasugrel in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: Analysis from the Acute Coronary Syndrome Israeli Survey". Cardiology 147, n.º 2 (22 de noviembre de 2021): 113–20. http://dx.doi.org/10.1159/000521042.
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<b><i>Introduction:</i></b> We aimed to compare the outcomes of acute coronary syndrome (ACS) patients undergoing in-hospital percutaneous coronary intervention treated with prasugrel versus ticagrelor. <b><i>Methods:</i></b> Among 7,233 patients enrolled to the Acute Coronary Syndrome Israeli Survey (ACSIS) between 2010 and 2018, we identified 1,126 eligible patients treated with prasugrel and 817 with ticagrelor. Comparison between the groups was performed separately in ST-elevation myocardial infarction (STEMI) patients, propensity score matched (PSM) STEMI patients, and non-ST-elevation ACS (NSTE-ACS) patients. <b><i>Results:</i></b> In-hospital complication rates, including rates of stent thrombosis, were not significantly different between groups. In PSM STEMI patients, 30-day re-hospitalization rate (<i>p</i> < 0.05), 30-day MACE (the composite of death, MI, stroke, and urgent revascularization, <i>p</i> = 0.006), and 1-year mortality rates (<i>p</i> = 0.08) were higher in the ticagrelor group compared to the prasugrel group; in NSTE-ACS patients, outcomes were not associated with drug choice. In Cox regression analysis applied on the entire cohort, prasugrel was associated with lower 1-year mortality in STEMI patients but not in NSTE-ACS patients (<i>p</i> for interaction 0.03). <b><i>Conclusions:</i></b> Compared to ticagrelor, prasugrel was associated with superior clinical outcomes in STEMI patients, but not in NSTE-ACS patients.
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Tsang, Michael y Sanjit Jolly. "Interventional Strategies in Thrombus Management for ST Elevation Myocardial Infarction". Interventional Cardiology Review 10, n.º 1 (2015): 35. http://dx.doi.org/10.15420/icr.2015.10.1.35.
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The major limitation of modern primary percutaneous coronary intervention (PPCI) is distal embolisation of thrombus and microvascular obstruction. Microvascular flow, as measured by myocardial blush grade (MPG), predicts mortality after PPCI. Despite initial enthusiasm, current evidence does not support routine use of Intracoronary over intravenous glycoprotein 2b3a inhibitors during PPCI for ST elevation myocardial infarction (STEMI) to improve clinical outcomes. Manual thrombectomy (MT) improves MPG and reduces distal embolisation in meta-analyses of small trials. A single-centre trial (N=1071), the Thrombus aspiration during percutaneous coronary intervention in acute myocardial infarction study (TAPAS) trial showed a mortality reduction, which led guidelines to recommend routine manual aspiration. However, the largest randomised trial (Thrombus aspiration in ST-elevation myocardial infarction in Scandinavia [TASTE] trial, N=7021) showed no difference in mortality and only trends towards reduction in myocardial infarction (MI) and stent thrombosis. The TASTE trial had much lower than expected mortality and so was likely underpowered for modest but important treatment effects (20–30 % RRR). The Thrombectomy with PCI versus PCI alone in patients with STEMI undergoing primary PCI (TOTAL) trial (N=10,700) will determine if MT reduces important clinical events during PPCI. Thrombus management remains an important area of research in STEMI.
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Jiang, Dongmei y Guosheng Fu. "A case of de Winter syndrome presenting with chest tightness". Journal of International Medical Research 49, n.º 7 (julio de 2021): 030006052110121. http://dx.doi.org/10.1177/03000605211012198.
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de Winter syndrome, also termed anterior ST-segment elevation myocardial infarction (STEMI) equivalent, is estimated to be present in approximately 2% of patients with acute myocardial infarction, but is often under-recognized by clinicians. Therefore, de Winter syndrome is associated with increased morbidity and mortality. We report a 51-year-old man with typical chest tightness and a characteristic electrocardiographic pattern without classic ST-segment elevation, but with acute nearly total occlusion of the left anterior descending coronary artery. Although the patient presented as a non-STEMI case, the definite diagnosis of de Winter syndrome was made on the basis of clinical and electrocardiographic findings. The patient’s symptom of chest tightness was relieved immediately after acute percutaneous coronary intervention and the left ventricular ejection fraction had not deteriorated at 1 month of follow-up.
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Djuric, Predrag, Slobodan Obradovic, Zoran Stajic, Marijan Spasic, Radomir Matunovic, Radoslav Romanovic, Nemanja Djenic y Zoran Jovic. "Very late stent thrombosis of bare-metal coronary stent nine years after primary percutaneous coronary intervention". Vojnosanitetski pregled 73, n.º 8 (2016): 774–78. http://dx.doi.org/10.2298/vsp141222053d.
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Introduction. Stent thrombosis (ST) in clinical practice can be classified according to time of onset as early (0?30 days after stent implantation), which is further divided into acute (< 24 hours) and subacute (1?30 days), late (> 30 days) and very late (> 12 months). Myocardial reinfaction due to very late ST in a patient receiving antithrombotic therapy is very rare, and potentially fatal. The procedure alone and related mechanical factors seem to be associated with acute/subacute ST. On the other hand, in-stent neoathero-sclerosis, inflammation, premature cessation of antiplatelet therapy, as well as stent fracture, stent malapposition, un-covered stent struts may play role in late/very late ST. Some findings implicate that the etiology of very late ST of bare-metal stent (BMS) is quite different from those following drug-eluting stent (DES) implantation. Case report. We presented a 56-year old male with acute inferoposterior ST segment elevation myocardial infarction (STEMI) related to very late stent thrombosis, 9 years after BMS implantation, despite antithrombotic therapy. Thrombus aspiration was successfully performed followed by percutaneous coronary intervention (PCI) with implantation of DES into the pre-viously implanted two stents to solve the in-stent restenosis. Conclusion. Very late stent thrombosis, although fortu-nately very rare, not completely understood, might cause myocardial reinfaction, but could be successfully treated with thrombus aspiration followed by primary PCI. Very late ST in the presented patient might be connected with neointimal plaque rupture, followed by thrombotic events.
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Vereshchagin, I. E., V. I. Ganyukov y I. N. Mamchur. "CARDIOPROTECTION IN PATIENTS WITH ACUTE ST SEGMENT ELEVATION MYOCARDIAL INFARCTION". Complex Issues of Cardiovascular Diseases 8, n.º 3 (26 de septiembre de 2019): 52–59. http://dx.doi.org/10.17802/2306-1278-2019-8-3-52-59.
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Aim To evaluate cardioprotective effects of combined intracoronary phosphocreatine and succinic acid administration after primary percutaneous coronary intervention (PCI) in patients with ST elevation acute coronary syndrome who were present within 12 hours of symptom onset.Methods Seven patients with STEMI presenting within 12 hours of onset of symptoms and thrombotic occlusion of the left anterior descending artery were included in the study. Evaluation of efficiency and safety was performed with the recording of major adverse cardiac events, evaluation of the procedure success, and the rate of composite endpoints.Results Six (85.7%) patients after primary PCI showed TIMI grade 3 flow on control coronary angiography. None complications had been reported after intracoronary administration of phosphocreatine and succinic acid. Acquired left ventricular aneurysms were found in two patients in the in-hospital period. One patient was readmitted with acute coronary syndrome without ST-segment elevation. Coronary angiography reported restenosis of the previously implanted stent. No definite increase in the left ventricular ejection fraction had been found in the in-hospital and long-term period.Conclusion There were no evidences on definite increase in myocardial contractility. The obtained results might partially be explained by the median symptom-to-balloon time over 400 minutes.
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Enache, Iulian, Răzvan Alexandru Radu, Elena Oana Terecoasă, Bogdan Dorobăţ y Cristina Tiu. "Stress cardiomyopathy misinterpreted as ST-segment elevation myocardial infarction in a patient with aneurysmal subarachnoid hemorrhage: a case report". Romanian Journal of Internal Medicine 58, n.º 3 (1 de septiembre de 2020): 173–77. http://dx.doi.org/10.2478/rjim-2020-0010.
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AbstractCardiac abnormalities are frequently reported in acute subarachnoid hemorrhage (SAH) patients. However, frank ST-elevation and myocardial dysfunction mimicking acute coronary syndrome is a rare occurrence. Systemic and local catecholamine release mediate myocardial injury and may explain raised troponin levels, concordant regional wall motion abnormalities and systolic dysfunction. These findings can pose a significant problem in the acute setting where “time-is-muscle” paradigm can rush clinicians towards a “rule-in” diagnosis of acute myocardial infarction.We present the case of a 60-year-old male who arrived at a regional emergency department with loss of consciousness, chest pain and headache. His ECG showed ST-elevation in precordial leads with corresponding region wall motion abnormalities and dynamically elevated troponin levels which supported a diagnosis of acute myocardial infarction. Percutaneous coronary intervention was attempted but found no hemodynamically significant lesions and the patient was managed conservatively with antithrombotic treatment. Further work-up for his headache led to the diagnosis of aneurysmal SAH and subsequent endovascular coiling. The patient was discharged with a good clinical outcome. We discuss the potential catastrophic consequences of interpreting neurologic myocardial stunning as STEMI. Use of potent antithrombotic therapies, like bridging thrombolysis, in this setting can lead to dismal consequences. Clinical history should still be carefully obtained in the acute setting in this era of sensitive biomarkers.
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Aghlmandi, Soheila, Nadine Schärer, Dik Heg, Lorenz Räber, Marcel Zwahlen, Baris Gencer, David Nanchen et al. "Thrombus aspiration in acute coronary syndromes: prevalence, procedural success, change in serial troponin T levels and clinical outcomes in a contemporary Swiss cohort". European Heart Journal: Acute Cardiovascular Care 7, n.º 6 (20 de abril de 2017): 522–31. http://dx.doi.org/10.1177/2048872617706480.
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Background: Randomised controlled trials have provided conflicting results regarding procedural and clinical outcomes of thrombus aspiration combined with percutaneous coronary intervention, when compared with primary percutaneous coronary intervention alone in patients with acute coronary syndromes. Methods: Acute coronary syndrome patients referred for coronary angiography to four Swiss university hospitals between 2009 and 2012 were enrolled in the SPUM–ACS cohort. At the discretion of the interventional cardiologist, patients underwent thrombus aspiration with percutaneous coronary intervention or percutaneous coronary intervention alone. Procedural success was defined as post-procedural thrombolysis in myocardial infarction III flow in the infarct-related artery. Serial changes in high-sensitivity troponin T (ΔhsTnT) and adjudicated 30 days (1 year) clinical events defined as the composite of cardiac death, recurrent myocardial infarction or clinically indicated coronary revascularisation were assessed. Results: Among 1641 patients, 777 (47.4%) had angiographic evidence of coronary thrombus. Patients were categorised into thrombus aspiration with percutaneous coronary intervention ( n=663) or percutaneous coronary intervention alone ( n=114). ST-segment elevation myocardial infarction (STEMI) patients more often received thrombus aspiration with percutaneous coronary intervention (87.8%) than non-STEMI patients (73.5%), P<0.001. Procedural success was not different in thrombus aspiration with percutaneous coronary intervention compared with percutaneous coronary intervention alone (93.8% vs. 90.7%, P=0.243). ΔhsTnT was similar in STEMI patients (3.09±4.52 vs. 2.19±4.92 µg/l, P=0.086) as was clinical outcome in the entire cohort at 30 days (2.9% vs. 3.6%, P=0.76) and 1 year (7.2% vs. 5.3%, P=0.55) regardless of whether thrombus aspiration was used during primary percutaneous coronary intervention or not. Conclusions: In this real-world acute coronary syndrome cohort, patients treated by thrombus aspiration with percutaneous coronary intervention showed no difference in the restoration of coronary blood flow compared with percutaneous coronary intervention alone immediately after the procedure. Furthermore, ΔhsTnT and clinical outcomes at either 30 days or 1 year were similar between thrombus aspiration with percutaneous coronary intervention or percutaneous coronary intervention alone. Clinical Trials Registration: SPUM–ACS cohort NCT01000701
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Crouch, Michael A., Jean M. Nappi y Kai I. Cheang. "Glycoprotein IIb/IIIa Receptor Inhibitors in Percutaneous Coronary Intervention and Acute Coronary Syndrome". Annals of Pharmacotherapy 37, n.º 6 (junio de 2003): 860–75. http://dx.doi.org/10.1345/aph.1c338.
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OBJECTIVE: To review the contemporary role of the glycoprotein (GYP) IIb/IIIa receptor inhibitors abciximab, eptifibatide, and tirofiban in patients undergoing percutaneous coronary intervention (PCI) and those with an acute coronary syndrome (ACS), and to provide an algorithm based on currently available evidence for specific agents. DATA SOURCES: Primary articles were identified by a MEDLINE search (1966–January 2003); references cited in these articles provided additional resources. STUDY SELECTION AND DATA EXTRACTION: All of the articles identified from data sources were considered for relevant information; this article primarily addresses large, controlled or comparative studies, and meta-analyses. DATA SYNTHESIS: The role of GYP IIb/IIIa inhibitors in patients undergoing PCI and those with ACS has progressed markedly. To date, abciximab has the most robust data in patients undergoing PCI, particularly high-risk individuals. In PCI patients with lower risk (e.g., elective stenting), eptifibatide is a reasonable first-line option. Data do not support tirofiban for routine use in patients undergoing PCI. For individuals with signs and symptoms of ACS, specifically unstable angina or non–ST-segment elevation myocardial infarction (MI), eptifibatide or tirofiban is recommended in high-risk patients when a conservative approach is used (PCI is not planned). Abciximab is not recommended in this situation. In patients with ST-segment elevation MI (STEMI), abciximab is the only GYP IIb/IIIa inhibitor evaluated in large, well-designed investigations. For medical management in combination with a fibrinolytic agent, the role of abciximab remains unclear. For patients undergoing primary PCI for the management of STEMI, the available evidence supports the use of abciximab, albeit further investigation is warranted. CONCLUSIONS: The role of GYP IIb/IIIa inhibitors in clinical cardiology continues to evolve. Choice of the agent depends on situation of use, patient-specific characteristics and risk stratification, and, in the case of ACS, chosen management strategy (medical management or intervention).
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Oktaviono, Yudi Her y Feranti Meuthia. "Thrombocytopenia in a Patient Undergoing Primary Percutaneous Coronary Intervention". Folia Medica Indonesiana 55, n.º 1 (14 de enero de 2021): 68. http://dx.doi.org/10.20473/fmi.v55i1.24434.
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Thrombocytopenia is a common abnormality in patients presenting with acute coronary syndrome. Baseline thrombocytopenia in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention is associated with early adverse events, related to both ischemia and bleeding. Treatment for acute coronary syndrome usually involves antiplatelet, anticoagulant, antithrombotic therapy, and the performance of percutaneous coronary intervention. The safety of antiplatelet therapy and percutaneous coronary intervention patients who have acute coronary syndrome and thrombocytopenia is unknown, and there are no guidelines or randomized studies that specifically suggest a treatment approach in such patients. One of the institutions in Italy recommends medical and interventional strategy with radialis as first choice for access site, bare metal stent (BMS) implantation, followed by double antiplatelet therapy (DAPT) for one month. After DAPT discontinuation, at least one antiplatelet drug (aspirin) is recommended for life.
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Ozaki, Yukio, Hironori Hara, Yoshinobu Onuma, Yuki Katagiri, Tetsuya Amano, Yoshio Kobayashi, Takashi Muramatsu et al. "CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) update 2022". Cardiovascular Intervention and Therapeutics 37, n.º 1 (enero de 2022): 1–34. http://dx.doi.org/10.1007/s12928-021-00829-9.
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AbstractPrimary Percutaneous Coronary Intervention (PCI) has significantly contributed to reducing the mortality of patients with ST-segment elevation myocardial infarction (STEMI) even in cardiogenic shock and is now the standard of care in most of Japanese institutions. The Task Force on Primary PCI of the Japanese Association of Cardiovascular Interventional and Therapeutics (CVIT) society proposed an expert consensus document for the management of acute myocardial infarction (AMI) focusing on procedural aspects of primary PCI in 2018. Updated guidelines for the management of AMI were published by the European Society of Cardiology (ESC) in 2017 and 2020. Major changes in the guidelines for STEMI patients included: (1) radial access and drug-eluting stents (DES) over bare-metal stents (BMS) were recommended as a Class I indication, (2) complete revascularization before hospital discharge (either immediate or staged) is now considered as Class IIa recommendation. In 2020, updated guidelines for Non-ST-Elevation Myocardial Infarction (NSTEMI) patients, the followings were changed: (1) an early invasive strategy within 24 h is recommended in patients with NSTEMI as a Class I indication, (2) complete revascularization in NSTEMI patients without cardiogenic shock is considered as Class IIa recommendation, and (3) in patients with atrial fibrillation following a short period of triple antithrombotic therapy, dual antithrombotic therapy (e.g., DOAC and single oral antiplatelet agent preferably clopidogrel) is recommended, with discontinuation of the antiplatelet agent after 6 to 12 months. Furthermore, an aspirin-free strategy after PCI has been investigated in several trials those have started to show the safety and efficacy. The Task Force on Primary PCI of the CVIT group has now proposed the updated expert consensus document for the management of AMI focusing on procedural aspects of primary PCI in 2022 version.
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Oktaviono, Yudi Her y Feranti Meuthia. "Case report: Thrombocytopenia in a Patient Undergoing Primary Percutaneous Coronary Intervention". Folia Medica Indonesiana 55, n.º 1 (9 de abril de 2019): 68. http://dx.doi.org/10.20473/fmi.v55i1.12562.
Texto completoResumen
Thrombocytopenia is a common abnormality in patients presenting with acute coronary syndrome. Baseline thrombocytopenia in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention is associated with early adverse events, related to both ischemia and bleeding. Treatment for acute coronary syndrome usually involves antiplatelet, anticoagulant, antithrombotic therapy, and the performance of percutaneous coronary intervention. The safety of antiplatelet therapy and percutaneous coronary intervention patients who have acute coronary syndrome and thrombocytopenia is unknown, and there are no guidelines or randomized studies that specifically suggest a treatment approach in such patients. One of the institutions in Italy recommends medical and interventional strategy with radialis as first choice for access site, bare metal stent (BMS) implantation, followed by double antiplatelet therapy (DAPT) for one month. After DAPT discontinuation, at least one antiplatelet drug (aspirin) is recommended for life.
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Cодномова, Лариса, Larisa Sodnomova, Наталья Булутова y Natalya Bulutova. "EFFICIENCY OF INVASIVE REVASCULARIZATION FOR ACUTE CORONARY SYNDROME WITH ST ELEVATION". Acta biomedica scientifica 2, n.º 5 (18 de enero de 2018): 55–59. http://dx.doi.org/10.12737/article_5a3a0dba5f2a88.40775068.
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The primary and main method of treating ACS with ST elevation is timely restoration of coronary vessel patency.
Material and methods. 273 medical records of patients admitted with provisional diagnosis of ACS with ST elevation
were studied. Statistical data were processed in Microsoft Excel and Statistica 10 (StatSoft Inc., USA).
Results. One third of patients with ACS with ST elevation were admitted at «the golden hour» since symptoms onset.
234 (86 %) patients underwent coronary angiography. Primary percutaneous intervention (PCI), coronary stenting were
performed for 117 patients, thrombolysis – for 23 and thrombolysis with subsequent PCI was carried out in 34 cases.
Assessment of RCI efficiency, invasive revascularization in terms of IM frequency and mortality showed the following:
the incidence of myocardial infarction in the group with PCI and without PCI was the same – 94 % against 98 % re-
spectively; however the mortality in patients with STEMI was lower in the group with performed invasive revascular-
ization – 4 % against 12 % (p = 0.04). Decrease is observed in both total mortality and mortality in the first 24 hours
for STEMI patients – 3 % in the PCI group, compared to 9 % in the other group (p = 0.04). The suvival rate for STEMI
patients was better for first time PCI – mortality 2.7 % against 12 % in the group without revascularization (p = 0.01).
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Stepinska, Janina, Izabela Wojtkowska, Lieven Annemans, Nicolas Danchin, Stuart J. Pocock, Frans Van de Werf, Jesús Medina y Hector Bueno. "Long-Term Outcome of Acute Coronary Syndromes in Patients on Chronic Oral Anticoagulants: Data from the EPICOR Study". Current Vascular Pharmacology 18, n.º 1 (18 de diciembre de 2019): 92–99. http://dx.doi.org/10.2174/1570161117666181227122355.
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Objective: To analyze characteristics, management and outcomes of patients with acute coronary syndromes (ACS) receiving chronic oral anticoagulant (OAC) therapy enrolled in the EPICOR (long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients) prospective, international, observational study of antithrombotic management patterns in ACS survivors (NCT01171404). Methods: This post-hoc analysis evaluated the association between OAC use at baseline (OACb) and time from hospital admission to percutaneous coronary intervention (PCI) (tHA-PCI), pre-PCI thrombolysis in myocardial infarction (TIMI) 3 flow, stent type, length of hospitalization, and clinical endpoints; death, non-fatal MI, and non-fatal stroke, a composite of these ± bleeding, over 2 years’ followup. Results: Of 10,568 ACS patients, 345 (3.3%) were on OACb (non-ST-segment elevation ACS [NSTEACS], n=268; ST-segment elevation MI [STEMI], n=77). OACb patients were older with more comorbidities. In NSTE-ACS OACb patients, tHA-PCI was longer (median 57.4 vs. 27.8 h; p=.008), and TIMI 3 flow rarer (26.0 vs. 33.5%; p=0.035). OACb patients had longer mean hospital stay (NSTEACS: 8.9 vs. 7.6 days; p<0.001; STEMI: 9.5 vs. 7.8 days; p=0.015), and higher rates of the composite endpoint (NSTE-ACS: 16.8 vs. 8.8%; p<0.0001; STEMI: 23.4 vs. 5.9%; p<0.0001). Bleeding events were more common with OACb (NSTE-ACS: 6.0 vs. 3.3%; p=0.01; STEMI: 6.5 vs. 2.8%; p=0.04). Conclusion: At 2-years, OACb use was associated with an increased risk of cardiovascular and bleeding events in STEMI and NSTE-ACS. NSTE-ACS patients on OACb experienced prolonged time to intervention, lower rates of TIMI 3 flow and longer hospitalization.
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Zameer, Imran, Muhammad Kashif, Akasha Perveez, Adnara Murad, Muhammad Asad, Muhammad Asad, Aleena Khan, Ayesha Sana y Azmat Hayat. "In-Hospital Outcomes of Patients Presenting with Acute Anterior STEMI with Right Bundle Branch Block". Pakistan Armed Forces Medical Journal 72, SUPPL-3 (29 de noviembre de 2022): S518–23. http://dx.doi.org/10.51253/pafmj.v72isuppl-3.9610.
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Objective: To assess the in-hospital outcomes in Anterior wall ST Elevation Myocardial Infarction patients presenting with Right Bundle Branch Block with different reperfusion strategies.
Study Design: Analytical Cross-Sectional Study.
Place and Duration of Study: Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi Pakistan, from Sep 2020 to Feb 2021.
Methodology: Patients with myocardial infarction who presented to the emergency department of the hospital were included in the study. Further evaluation was performed on individuals with ST elevation in anterior chest leads and new-onset or presumably new Right bundle branch block on electrocardiogram. Anterior wall myocardial infarction was diagnosed based on 4th universal definition of Myocardial infarction. Patients excluded were those with non-anterior ST-elevation myocardial infarction, prior coronary artery bypass grafting, previous percutaneous coronary intervention, or Left bundle branch block.The treatment plan was chosen by the interventional cardiologist. Various parameters were used to measure the outcomes ofdifferent therapies.
Results: 93 patients were included with 72(77.4%) males and 21 females (22.5%). Mean age was 59.91±11.93 years. Premorbid seen was 41.9% diabetes, 32.3% hypertension, 18.3% smoking. Transient RBBB was seen in 64.5% of the study population and persistence RBBB was 35.5%. Mortality was associated with higher Killip class (p=<0.001), AV block (p=0.078), increased no of coronary vessels involved (p=0.014), increased amplitude of ST elevation (p=0.083) and with lower EF values (p=0.032). Worst outcomes were common in patients on medical treatment.
Conclusion: Poor outcomes in Anterior Wall Myocardial Infarction with Right Bundle Branch Block are linked to length ofstay, co morbidities, Killip class, amplitude of ST elevation, coronary artery disease complexity and those managed on medicaltreatment.
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Shaikh, Sanaullah, Vashu Mal, Jagdesh Kumar, Suhail Ahmed, Faraz Farooq Memon y Bilawal Adrani. "The Frequency of Early Subacute Stent Thrombosis after Primary Percutaneous Coronary Intervention in Patients with St-Segment Elevation Myocardial Infarction". Pakistan Journal of Medical and Health Sciences 16, n.º 1 (30 de enero de 2022): 530–34. http://dx.doi.org/10.53350/pjmhs22161530.
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Introduction: Acute coronary syndrome(ACS) is associated with activation ofplateletsand thecoagulationsystem which could influence the incidence of early stentthrombosis(EST).Stent thrombosis is a relatively uncommon phenomenon, yet it is a serious complication which often presents as an ST-segment elevation myocardial infarction (STEMI) and/or sudden cardiac death1,2.Stent thrombosis (ST) is an uncommon but life-threatening complication after percutaneous coronary intervention (PCI), frequently manifesting as acute coronary syndrome (ACS) or even cardiac death.Platelet activation and the heightening of the coagulation system play a major role in the pathogenesis of acute coronary syndrome (ACS) and might impact the occurrence of stent thrombosis in those patients who undergo stenting during ACS. Unfortunately, stent thrombosis (ST) is more frequent after stenting for STEMI than after elective stenting with both drug-eluting stents (DES) and baremetal stents (BMS). Objective: To determine the frequency of early subacute stent thrombosis after primary percutaneous coronary intervention in patients with STsegment elevation myocardial infarction Methodology: Study Design: Descriptive Case Series Setting: This study was conducted in NICVD Hospital, Karachi Subjects and Methods: Study was approved by hospital ethical review committee. All patients who fulfilled the inclusion criteria were included in the study. Pre-operatively a written consent was taken from each patient by the primary investigator of this study. All these patients were undergone primary PCI and stent either drug-eluting stents (coated with medication) or bare-metal stent was placed. These patients were observed for 24 hours for early subacute stent thrombosis. All the collected data were entered into the proforma attached at the end. Results: Mean ± SD of age was 55.56±12.24 with C.I (53.52------57.59) years. Mean ± SD duration of surgery was 33.48±9.26 with C.I (31.90------35.05) minutes. Out of 142 patients 103 (72.53%) were male and 39 (27.4%) were female. Frequency of early subacute stent thrombosis was found to be 4(2.82%). Conclusion: It is to be concluded that frequency of early acute stent thrombosis after primary PCI was found to be 2.82%.Patients presenting with STEMI who are hemodynamically unstable and have multivessel coronary disease undergoing coronary stenting during ACS, are at increased risk of EST. Keywords: Acute myocardial Infarction, Primary PCI, Early Subacute Stent, Thrombosis, STEMI
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Fernández-Bergés, Daniel, Irene R. Degano, Reyes Gonzalez Fernandez, Isaac Subirana, Joan Vila, Manuel Jiménez-Navarro, Silvia Perez-Fernandez et al. "Benefit of primary percutaneous coronary interventions in the elderly with ST segment elevation myocardial infarction". Open Heart 7, n.º 2 (agosto de 2020): e001169. http://dx.doi.org/10.1136/openhrt-2019-001169.
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ObjectivePrimary percutaneous coronary intervention (P-PCI) has demonstrated its efficacy in patients with ST segment elevation myocardial infarction (STEMI). However, patients with STEMI ≥75 years receive less P-PCI than younger patients despite their higher in-hospital morbimortality. The objective of this analysis was to determine the effectiveness of P-PCI in patients with STEMI ≥75 years.MethodsWe included 979 patients with STEMI ≥75 years, from the ATención HOspitalaria del Síndrome coronario study, a registry of 8142 consecutive patients with acute coronary syndrome admitted at 31 Spanish hospitals in 2014–2016. We calculated a propensity score (PS) for the indication of P-PCI. Patients that received or not P-PCI were matched by PS. Using logistic regression, we compared the effectiveness of performing P-PCI versus non-performance for the composite primary event, which included death, reinfarction, acute pulmonary oedema or cardiogenic shock during hospitalisation.ResultsOf the included patients, 81.5 % received P-PCI. The matching provided two groups of 169 patients with and without P-PCI. Compared with its non-performance, P-PCI presented a composite event OR adjusted by PS of 0.55 (95% CI 0.34 to 0.89).ConclusionsReceiving a P-PCI was significantly associated with a reduced risk of major intrahospital complications in patients with STEMI aged 75 years or older.
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Hadadi, László, Paul Calburean, Paul Grebenisan, Victor Vacariu, Reka-Katalin Drincal, Oana Tepes, Iulia Grancea et al. "Mortality predictors after percutaneous coronary intervention – a prospective single-center registry study". Romanian Journal of Cardiology 30, n.º 3 (1 de octubre de 2020): 413–22. http://dx.doi.org/10.47803/rjc.2020.30.3.413.
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Objectives – To evaluate the predictors of three-year cardiovascular mortality after percutaneous coronary intervention (PCI) in a Romanian tertiary cardiovascular center. Methods – Consecutive patients treated by PCI in the Emergency Institute for Cardiovascular Diseases and Transplantation of Targu Mures were included prospectively in a local PCI Registry. Demographic, clinical, and procedural parameters of the patients enrolled in the year 2016 were statistically analyzed as possible predictors of three-year cardiovascular mortality post-PCI. Results – 1079 patients were included: 254 (23.5%) with ST-segment elevation acute myocardial infarction (STEMI), 278 (25.8%) with non-ST segment elevation acute coronary syndrome (NSTEACS) and 547 (50.7%) with chronic coronary syndrome (CCS). Three-year cardiovascular mortality was 20.1%, 10.8% and 5.7% after PCI for STEMI, NSTEACS and CCS, respectively. Cox proportional hazards regression evidenced as independent predictors of long-term mortality after PCI: low left ventricular ejection fraction (LVEF), renal dysfunction, presentation with cardiogenic shock or with cardiac arrest in the case of acute coronary syndromes, and the history of signifi cant valvular heart disease and low LVEF in the case of CCS (all p ≤0.01). Conclusions – Simple clinical variables but no procedural factors were the main predictors of 3-year cardiovascular mortality after PCI in this all-comers population.
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Baumann, Angus A. W., Aashka Mishra, Matthew I. Worthley, Adam J. Nelson y Peter J. Psaltis. "Management of multivessel coronary artery disease in patients with non-ST-elevation myocardial infarction: a complex path to precision medicine". Therapeutic Advances in Chronic Disease 11 (enero de 2020): 204062232093852. http://dx.doi.org/10.1177/2040622320938527.
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Recent analyses suggest the incidence of acute coronary syndrome is declining in high- and middle-income countries. Despite this, overall rates of non-ST-elevation myocardial infarction (NSTEMI) continue to rise. Furthermore, NSTEMI is a greater contributor to mortality after hospital discharge than ST-elevation myocardial infarction (STEMI). Patients with NSTEMI are often older, comorbid and have a high likelihood of multivessel coronary artery disease (MVD), which is associated with worse clinical outcomes. Currently, optimal treatment strategies for MVD in NSTEMI are less well established than for STEMI or stable coronary artery disease. Specifically, in relation to percutaneous coronary intervention (PCI) there is a paucity of randomized, prospective data comparing multivessel and culprit lesion-only PCI. Given the heterogeneous pathological basis for NSTEMI with MVD, an approach of complete revascularization may not be appropriate or necessary in all patients. Recognizing this, this review summarizes the limited evidence base for the interventional management of non-culprit disease in NSTEMI by comparing culprit-only and multivessel PCI strategies. We then explore how a personalized, precise approach to investigation, therapy and follow up may be achieved based on patient-, disease- and lesion-specific factors.
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Montone, Rocco A., Giampaolo Niccoli, Filippo Crea y Ik-Kyung Jang. "Management of non-culprit coronary plaques in patients with acute coronary syndrome". European Heart Journal 41, n.º 37 (17 de julio de 2020): 3579–86. http://dx.doi.org/10.1093/eurheartj/ehaa481.
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Abstract Approximately 50% of patients with ST-segment elevation myocardial infarction (STEMI) have multivessel coronary artery disease, a condition associated with an increased incidence of recurrent ischaemic events and higher mortality. Based on recent evidences, a strategy of staged percutaneous coronary intervention (PCI) of obstructive non-culprit lesions should be considered the gold standard for the management of these patients. However, several issues remain still unresolved. Indeed, what is the optimal timing of staged PCI is not completely defined. Moreover, assessment of intermediate non-culprit lesions represent still a clinical conundrum, as pressure-wire indexes do not seem able to correctly identify those patients in whom deferral is safe. Intracoronary imaging may help to identify untreated non-culprit lesions containing vulnerable plaques that may portend a higher risk of future cardiovascular events. However, there are hitherto no studies demonstrating that preventive PCI of vulnerable plaques or more intensive pharmacological treatment is associated with an improved clinical outcome. In this review, we discuss the recent evolving concepts about management of non-culprit plaques in STEMI patients, proposing a diagnostic and therapeutic algorithm to guide physicians in clinical practice. We also underscore the several knowledge gaps to address in future studies.
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Sen, Gautam, Alice Veitch y Sergio Nabais. "Anterior STEMI complicating acute aortic syndrome: mechanistic insight and bridge to surgery with intravascular ultrasound-guided primary PCI". BMJ Case Reports 15, n.º 3 (marzo de 2022): e248055. http://dx.doi.org/10.1136/bcr-2021-248055.
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Stanford type A acute aortic syndromes (AAS) can be complicated with acute coronary closure and ST segment elevation myocardial infarction (STEMI) leading to significant additional morbidity and mortality. The recommended treatment for type A AAS is emergency cardiac surgery. We present the case of a patient with intramural haematoma involving the ascending and descending aorta complicated with anterior wall STEMI after CT imaging. Coronary angiography and intravascular ultrasonography (IVUS) revealed the dissection spiralling into the media of the left main stem (LMS) and left anterior descending (LAD) coronary artery. In the setting of acute vessel closure and ongoing myocardial ischaemia primary percutaneous coronary intervention (PCI) was performed to the LMS, LAD and second diagonal branch prior to successful emergency cardiac surgery with an aortic-arch interposition graft. Emergency IVUS-guided stenting to relieve acute coronary occlusion in the context of aortic dissection can be performed in selected cases to safely bridge the patient for cardiac surgery.
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Lazar, Roxana-Daiana, Abigaela Rus, Cosmin Tolescu, Renata Gerculy, Diana Opincariu y Imre Benedek. "Spontaneous Coronary Artery Dissection and Anomalous Coronary Origin – Underlying Cause of Acute Coronary Syndrome in a Young Woman: A Case Report". Journal Of Cardiovascular Emergencies 7, n.º 1 (1 de marzo de 2021): 22–26. http://dx.doi.org/10.2478/jce-2020-0017.
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Abstract Introduction: Spontaneous coronary artery dissection (SCAD) represents a very rare and poorly understood condition that is gaining recognition as an important cause of myocardial infarction, especially among young women. The pathogenesis of SCAD is not well established yet, but several theories have been proposed. Case presentation: We report the case of a 25-year-old woman without any history of cardiovascular disease who presented with acute anterior ST-elevation myocardial infarction (STEMI) due to the luminal obstruction generated by an intramural hematoma from a SCAD of the left main coronary artery, which was successfully treated by coronary artery stenting. Additionally, the patient presented anomalies of coronary origins (ACO) with separate emergences of the left anterior descending (LAD) artery from the left coronary cusp and the left circumflex artery (LCX) from the right coronary cusp, with no apparent clinical significance. Conclusion: SCAD should always be included in the differential diagnosis of young patients presenting with STEMI. In case of prompt diagnosis, SCAD-STEMI patients are successfully treated with percutaneous coronary intervention (PCI). Moreover, it is of vital importance to identify variants of ACO, even without clinical relevance at the moment of the acute event, in order to initiate an appropriate management, since ACO increases the risk of routine PCI.
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Opolonskaya, P. E., N. I. Maximov y M. Yu Smetanin. "Effect of obstructive sleep apnea syndrome on left ventricular remodeling in acute ST-elevation myocardial infarction after percutaneous coronary intervention". Siberian Journal of Clinical and Experimental Medicine 35, n.º 3 (17 de octubre de 2020): 100–106. http://dx.doi.org/10.29001/2073-8552-2020-35-3-100-106.
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Introduction. Patients with obstructive sleep apnea syndrome (OSA) may have features of acute ST-segment elevation myocardial infarction (STEMI). We assumed that the previous OSA due to acute and chronic hypoxia has a “protective” effect on myocardial damage in STEMI. To assess the damage to the myocardium, we selected the index of local contractility disorders (ILCD), and used the oxygen desaturation index (ODI) to assess OSA’s severity.Aim. To study the relationship between myocardial damage and the severity of OSA in STEMI after percutaneous coronary intervention (PCI).Material and Methods. We examined 130 patients with first-time STEMI after PCI on the infarct-associated coronary artery. Examination and treatment of patients were performed based on current procedures and standards of medical care and clinical recommendations. All patients were monitored for pulse oximetry during nighttime sleep within one week after hospitalization. The patients were divided into two groups: group A (n=59, ODI 0-5/hour, STEMI without OSA) and group B (n=71, ODI >5/ hour, STEMI with OSA).Results. Regression analysis showed that the elements of myocardium’s structural remodeling, the severity of OSA, and some biochemical indicators are included in the same indicator system and are associated with ILCD. The “left ventricular ejection fraction” (“LVEF”) indicator, estimated using the J.S. Simpson method, had the largest contribution to the ILCD in both groups of patients, while the “ID” indicator backfired on ILCD only in the group of STEMI with OAS. Thus, OSA contributed to less damage to the left ventricular myocardium in STEMI.
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Wiggins, Barbara S. y Sarah Spinler. "Antiplatelet and Antithrombin Therapy for Early Management of Acute Coronary Syndromes". Journal of Pharmacy Practice 17, n.º 5 (octubre de 2004): 347–69. http://dx.doi.org/10.1177/0897190004271778.
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Acute coronary syndromes (ACS) are defined as either unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), or ST-segment elevation myocardial infarction (STEMI). Their management is continuously evolving in terms of pharmacologic therapy. The usual cause of ACS is the disruption of an atherosclerotic plaque leading to formation of a thrombus within a coronary artery. Initial antiplatelet and antithrombin therapy for patients with ST-segment elevation (STE) ACS includes aspirin and unfractionated heparin (UFH). Patients presenting to the hospital early may undergo percutaneous intervention (PCI) with administration of additional medications such as clopidogrel and abciximab or may receive a fibrinolytic agent. Patients with non-ST-segment elevation (NSTE) ACS receive aspirin, clopidogrel, either a low-molecular-weight heparin or UFH, and, in selected patients, a glycoprotein (GP) IIb/IIIa receptor blocker. All of these agents have shown benefit when administered to patients with ACS, but results vary depending on the type of syndrome, timing of administration, and patient’s overall risk. Their mechanism of action, role in ACS, clinical practice recommendations, adverse effects, and monitoring are reviewed. Some inherent limitations to agents such as aspirin and UFH require the need for newer treatment approaches. Therefore, newer classes of drugs such as the direct thrombin inhibitor bivalirudin and the selective factor Xa inhibitor fondaparinux are being explored as alternatives to heparins for ACS management.
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Galappatthy, Priyadarshani, Vipula R. Bataduwaarachchi, Priyanga Ranasinghe, Gamini K. S. Galappatthy, Maheshi Wijayabandara, Dinuka S. Warapitiya, Mythily Sivapathasundaram et al. "Management, characteristics and outcomes of patients with acute coronary syndrome in Sri Lanka". Heart 104, n.º 17 (16 de febrero de 2018): 1424–31. http://dx.doi.org/10.1136/heartjnl-2017-312404.
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BackgroundIschaemic heart disease is the leading cause of in-hospital mortality in Sri Lanka. Acute Coronary Syndrome Sri Lanka Audit Project (ACSSLAP) is the first national clinical-audit project that evaluated patient characteristics, clinical outcomes and care provided by state-sector hospitals.MethodsACSSLAP prospectively evaluated acute care, in-hospital care and discharge plans provided by all state-sector hospitals managing patients with ACS. Data were collected from 30 consecutive patients from each hospital during 2–4 weeks window. Local and international recommendations were used as audit standards.ResultsData from 87/98 (88.7%) hospitals recruited 2177 patients, with 2116 confirmed as having ACS. Mean age was 61.4±11.8 years (range 20–95) and 58.7% (n=1242) were males. There were 813 (38.4%) patients with unstable angina, 695 (32.8%) with non-ST-elevation myocardial infarction (NSTEMI) and 608 (28.7%) with ST-elevation myocardial infarction (STEMI). Both STEMI (69.9%) and NSTEMI (61.4%) were more in males (P<0.001). Aspirin, clopidogrel and statins were given to over 90% in acute setting and on discharge. In STEMI, 407 (66.9%) were reperfused; 384 (63.2%) were given fibrinolytics and only 23 (3.8%) underwent primary percutaneous coronary intervention (PCI). Only 42.3 % had thrombolysis in <30 min and 62.5% had PCI in <90 min. On discharge, beta-blockers and ACE inhibitors/angiotensin II receptor blockers were given to only 50.7% and 69.2%, respectively and only 17.6% had coronary interventions planned.ConclusionsIn patients with ACS, aspirin, clopidogrel and statin use met audit standards in acute setting and on discharge. Vast majority of patients with STEMI underwent fibrinolyisis than PCI, due to limited resources. Primary PCI, planned coronary interventions and timely thrombolysis need improvement in Sri Lanka.
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Sultana, Syeda Aleya, Syed Asif Iqbal, Md Abdul Malek, Md Wali Ur Rahman, Abu Yusuf Md Shahidul Alam, Md Aminul Haque y Safia Binte Rabbani. "A Comparative Study on Short-term Clinical Outcome in Acute Coronary Syndrome". Journal of Armed Forces Medical College, Bangladesh 13, n.º 1 (21 de abril de 2017): 22–27. http://dx.doi.org/10.3329/jafmc.v13i1.41011.
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Introduction: Coronary artery diseases are currently the major cause of death in developing countries. Acute coronary syndrome (ACS) is defined as any group of clinical symptoms compatible with acute myocardial ischemia and covers the spectrum of clinical conditions ranging from unstable angina (UA) to non-ST elevation myocardial infarction (NSTEMI) to STelevation myocardial infarction (STEMI). Accurate diagnosis and management of ACS has life-saving implications of its outcome.
Objective: To compare the outcomes of STEMI and NSTEMI in a percutaneous coronary intervention (PCI) capable centre.
Materials and Methods: The patients who undergone percutaneous coronary intervention (PCI) in Combined Military Hospital, Dhaka were considered from January 2013 to January 2017. Diagnosis of acute MI was based on the clinical presentation, electrocardiogram (ECG) and raised highly sensitive troponin I. Acute MI patients were classified into 2 groups, STEMI and NSTEMI. Their coronary risk factors, co-morbidity, ECG, echocardiogram, coronary angiographic (CAG) findings and short-term outcomes were collected. All statistical data were analysed by SPSS 22.0 software.
Results: There were 464 patients enrolled for analysis. Among them, 208(44.8%) patients had STEMI and 256(55.2%) had NSTEMI. The ratio of male/female was greater in STEMI as compared to NSTEMI (4.0 vs 1.9; p=0.041). Among NSTEMI patients, 88(34.4%) had ST depression, 168(65.6%) patients had other ECG changes like T wave abnormalities in 66(25.7%) and poor R-wave progression in 16(6.3%). NSTEMI patients had less regional wall motion abnormality on echo cardiogram (p=0.0045). As a complication heart failure (36% vs 9.3%), cardiogenic shock (16.8% vs 15.6%), atrial fibrillation (7.2 vs 0.78 %), ventricular tachycardia (2.8% vs 0.5%), reinfarction (3 % vs 0.78%) and death (2.4% vs 0.40%) were observed more in STEMI patients than NSTEMI respectively. NSTEMI patients had less regional wall motion abnormality on echocardiogram (p=0.0045). As a complication heart failure (36% vs 9.3%), cardiogenic shock (16.8% vs 15.6%), atrial fibrillation (7.2% vs 0.78%), ventricular tachycardia (2.8% vs 0.5%), reinfarction (3% vs 0.78%) and death (2.4% vs 0.40%) were observed more in STEMI patients than NSTEMI respectively. Coronary angiogram shows that left anterior descending artery was the most commonly involved artery in STEMI; however, the left circumflex artery or right coronary artery was involved more commonly in NSTEMI (p<0.001).
Conclusion: The first step in successful treatment of acute MI depends on early diagnosis. Inspite of immediate management, STEMI had relatively worse outcome compared to NSTEMI.
Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 22-27
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Liu, Yuan-Hui, Lei Jiang, Chong-Yang Duan, Peng-Cheng He, Yong Liu, Ning Tan y Ji-Yan Chen. "Canada Acute Coronary Syndrome Score: A Preprocedural Risk Score for Contrast-Induced Nephropathy After Primary Percutaneous Coronary Intervention". Angiology 68, n.º 9 (31 de enero de 2017): 782–89. http://dx.doi.org/10.1177/0003319717690674.
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In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention, contrast-induced nephropathy (CIN) is a serious complication associated with poor outcomes. We assessed the predictive value of the Canada Acute Coronary Syndrome (C-ACS) score for CIN in these patients. A total of 394 consecutive patients with STEMI were enrolled and divided into 3 groups according to their C-ACS scores—group 1, score 0; group 2, score 1; and group 3, score ≥2. The clinical outcomes were CIN and major adverse clinical events (MACEs) during hospital and follow-up; 8.4% of patients developed CIN. Patients with high C-ACS scores were more likely to develop CIN, in-hospital death, and MACEs ( P < .001). The C-ACS score was an independent predictor of CIN (odds ratio = 2.87; 95% confidence interval = 1.78-4.63; P < .001) and risk factor for long-term MACEs. The C-ACS score had good predictive values for CIN, in-hospital morality, MACEs, and long-term mortality. Patients with high C-ACS risk scores exhibited a worse survival rate than those with low scores (death, P = .02; MACEs, P = .006). In conclusion, in patients with STEMI, the C-ACS could predict CIN and clinical outcomes.
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M, Anupama, Sharath JV y Shetty GG. "A study to compare fibrinolytic therapy versus primary percutaneous coronary intervention in ST-segment elevation myocardial infarction in a tertiary care hospital". National Journal of Physiology, Pharmacy and Pharmacology 13, n.º 5 (2022): 1. http://dx.doi.org/10.5455/njppp.2023.13.09472202202102022.
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Background: ST-segment elevation myocardial infarction (STEMI) is the most dramatic manifestation of coronary artery disease, acute STEMI is a clinical syndrome defined by characteristic symptoms of myocardial ischemia in association with persistent electrocardiographic ST elevation and subsequent release of biomarkers of myocardial necrosis. Reperfusion with thrombolysis or PCI (percutaneous coronary intervention) is the current standard of care for STEMI. Aims and Objectives: The aim of the study was to compare the effectiveness of fibrinolytic therapy and primary PCI which are the available reperfusion strategies for STEMI. Materials and Methods: This prospective and observational study was conducted at a tertiary care hospital in Bangalore. Patients presenting with STEMI to emergency department were treated with either fibrinolysis or PCI as per protocol. Patients in each arm were followed up to know the differences in outcome at discharge and 30-day follow-up. Results: Patients admitted with STEMI had overall in hospital mortality of 17 (7.1%) patients, of which 9 (7.6%) patients were from fibrinolysis group and 8 (6.6%) patients from PCI group with no statistically significant difference (P = 0.760). There was significant incidence (P = 0.001) of reinfarct in fibrinolysis group (9.3%) when compared to PCI group (0%). Conclusion: There was no statistically significant mortality difference at discharge and at 30 day between fibrinolysis and primary PCI in patients with STEMI in our study, this may be attributed to use of rescue PCI in failed fibrinolysis patients and early tricuspid valve repair in many patients after fibrinolysis.
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Aurigemma, Cristina, Giancarla Scalone, Fabrizio Tomai, Luca Altamura, Giovanni De Persio, Alessandra Stazi, Filippo Crea y Gaetano A. Lanza. "Persistent enhanced platelet activation in patients with acute myocardial infarction and coronary microvascular obstruction: clinical implications". Thrombosis and Haemostasis 111, n.º 01 (2014): 122–30. http://dx.doi.org/10.1160/th13-02-0166.
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SummaryAbout 30% of patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing recanalisation of the infarct-related coronary artery do not achieve valid myocardial reperfusion (no-reflow phenomenon or coronary microvascular obstruction [MVO]). The mechanisms of MVO are incompletely understood. In this study we investigated the role platelet activation in the pathogenesis of coronary MVO in STEMI patients. We enrolled 48 STEMI patients (age 56.2 ± 11 years; 31 men), treated by primary percutaneous coronary intervention (PCI) followed by double anti-platelet treatment, and 20 control patients with stable coronary artery disease (CAD) on single antiplatelet treatment (age 57.5 ± 6 years, 12 men). STEMI patients were divided into two groups: 35 patients with complete myocardial reperfusion (MR) and 13 patients with coronary MVO despite successful PCI. Platelet activation was assessed on admission and at one-month follow-up by measuring platelet receptor expression and monocyteplatelet aggregates (MPAs). Platelet receptor expression, platelet receptor conformational change for fibrinogen binding availability and MPA formation were increased in STEMI patients with MVO compared to both STEMI patients with MR and stable CAD patients, both on admission and at one-month follow-up (p<0.05 for all). Among STEMI patients, platelet activation is greater in those who display coronary MVO, compared to those with MR, after successful PCI, both on admission and one month after STEMI, suggesting that enhanced platelet activation might be involved in the pathogenesis of MVO. The persistence of enhanced platelet activation despite double classical anti-platelet therapy suggests that new anti-platelet strategies should be considered in patients with coronary MVO.
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Christ, Günter, Jolanta M. Siller-Matula, Marcel Francesconi, Cornelia Dechant, Katharina Grohs y Andrea Podczeck-Schweighofer. "Individualising dual antiplatelet therapy after percutaneous coronary intervention: the IDEAL-PCI registry". BMJ Open 4, n.º 10 (octubre de 2014): e005781. http://dx.doi.org/10.1136/bmjopen-2014-005781.
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ObjectiveTo evaluate the clinical utility of individualising dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in an all-comers population, including ST-elevation myocardial infarction (STEMI) patients.SettingTertiary care single centre registry.Participants1008 consecutive PCI patients with stent implantation, without exclusion criteria.InterventionPeri-interventional individualisation of DAPT, guided by multiple electrode aggregometry (MEA), to overcome high on-treatment platelet reactivity (HPR) to ADP-induced (≥50 U) and arachidonic acid (AA)-induced aggregation (>35 U).Outcome measuresThe primary efficacy end point was definite stent thrombosis (ST) at 30 days. The primary safety end point was thrombolysis in myocardial infarction (TIMI) major and minor bleeding. Secondary end points were probable ST, myocardial infarction, cardiovascular death and the combined end point: major cardiac adverse event (MACE).Results53% of patients presented with acute coronary syndrome (9% STEMI, 44% non-ST-elevation). HPR to ADP after 600 mg clopidogrel loading occurred in 30% of patients (73±19 U vs 28±11 U; p<0.001) and was treated by prasugrel or ticagrelor (73%), or clopidogrel (27%) reloading (22±12 U; p<0.001). HPR to ADP after prasugrel loading occurred in 2% of patients (82±26 U vs 19±10 U; p<0.001) and was treated with ticagrelor (34±15 U; p=0.02). HPR to AA occurred in 9% of patients with a significant higher proportion in patients with HPR to ADP (22% vs 4%, p<0.001) and was treated with aspirin reloading. Definite ST occurred in 0.09% of patients (n=1); probable ST, myocardial infarction, cardiovascular death and MACE occurred in 0.19% (n=2), 0.09% (n=1) and 1.8% (n=18) of patients. TIMI major and minor bleeding did not differ between patients without HPR and individualised patients (2.6% for both).ConclusionsIndividualisation of DAPT with MEA minimises early thrombotic events in an all-comers PCI population to an unreported degree without increasing bleeding. A randomised multicentre trial utilising MEA seems warranted.Trial registration numberhttp://www.clinicaltrials.gov; NCT01515345.
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Bocharov, Aleksandr V. y Leonid V. Popov. "Comparison of strategies for myocardial revascularization in patients with coronary heart disease and multivessel coronary artery disease". Journal of Clinical Practice 10, n.º 4 (13 de febrero de 2020): 30–35. http://dx.doi.org/10.17816/clinpract12631.
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Justification. To this day, the problem of choosing the method of complete revascularization in the category of patients with acute coronary syndrome without the ST segment elevation and multi-vascular lesions of the coronary bed does not lose its relevance. The goal of this study was to compare the results of surgical manipulations in patients who underwent percutaneous coronary intervention using 3rd-generation drug-coated stents and coronary artery bypass grafting, according to the two-year follow-up data.
Methods. The results of surgical and endovascular revascularization strategies were compared in 140 patients with ischemic heart disease and multivessel coronary disease after previously successfully performed stenting of a clinically dependent artery using 3rd-generation drug-coated stents for acute coronary syndrome without the ST segment elevation based on the results of a two-year follow-up.
Results. There were no statistically significant differences in clinical, demographic and operational characteristics between the groups, except for the number of smoking patients, wich was significantly higher in the PCI group. In the PCI group, there was a statistically significant difference in the frequency of repeated revascularizations and the combined MACCE point.
Discussion. The obtained results showed the advantage of CABG in a group of patients with previously successfully performed PCI of the clinically dependent artery for non -STEMI and multi-vascular lesions.
Conclusion. In patients with coronary artery disease and multivascular lesions of the coronary bed, who had successfully underwent stenting of the clinical-dependent artery using stents of the 3rd generation with drug coating for acute coronary syndrome without the ST segment elevation, and intermediate severity of lesions on the SYNTAX scale when performing full functional revascularization by coronary artery bypass grafting or stenting, there are no differences in the indicators of cardiovascular mortality, myocardial infarction, acute cerebrovascular disease, frequency of return of the clinic angina pectoris, with the exception of the frequency of repeated revascularization and composite MACCE points, which was statistically significantly higher in the group of stenting.
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Chen, Hongwu, Xiaofan Yu, Xiangyong Kong, Longwei Li, Jiawei Wu y Likun Ma. "Efficacy and safety of bivalirudin application during primary percutaneous coronary intervention in older patients with acute ST-segment elevation myocardial infarction". Journal of International Medical Research 48, n.º 9 (septiembre de 2020): 030006052094794. http://dx.doi.org/10.1177/0300060520947942.
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Objective ST-segment elevation myocardial infarction (STEMI) is the most serious type of acute coronary syndrome. This study aimed to investigate the efficacy and safety of bivalirudin application during primary percutaneous coronary intervention (PPCI) in older patients with acute STEMI. Methods A total of 672 older patients with STEMI (>75 years) who underwent PPCI were studied. The primary endpoints were 30-day net adverse clinical events (NACEs) post-emergency percutaneous coronary intervention, including major adverse cardiac and cerebrovascular events (MACCEs) and Bleeding Academic Research Consortium grades 2 to 5 (BARC 2–5) bleeding events. Results The incidence of NACEs and BARC 2–5 bleeding events in the bivalirudin group was significantly lower than that in the unfractionated heparin group. Multivariate Cox regression analysis showed that bivalirudin significantly reduced 30-day NACEs (odds ratio: 0.700, 95% confidence interval: 0.492–0.995) and BARC 2–5 bleeding events (odds ratio: 0.561, 95% confidence interval: 0.343–0.918). At 1-year follow-up, these results were similar. Conclusions Bivalirudin can be safely and effectively used during PPCI in older patients with STEMI. Bivalirudin reduces the risks of NACEs and bleeding within 30 days after PPCI, without increasing the risks of MACCEs and stent thrombosis compared with heparin.
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Ryabov, V. V., S. K. Demianov, A. G. Syrkina, N. V. Belokopitova, E. V. Vyshlov, I. V. Maximov, A. E. Baev, V. A. Markov y R. S. Karpov. "Quality of care for patients with myocardial infarction with ST segment elevation. real clinical practice of the invasive center." Clinical Medicine (Russian Journal) 96, n.º 6 (11 de noviembre de 2018): 506–11. http://dx.doi.org/10.18821/0023-2149-2018-96-6-506-511.
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According to the Russian registry RECORD, the hospital mortality at STEMI in domestic hospitals remains high, which is due to the low frequency of reperfusion measures. There are problems in treatment patients of senile age. Comparative studies of the quality of care for patients with acute coronary syndrome were not conducted in Russia. 489 patients with STEMI, arrived in the first 24 hours from the onset of MI were analyzed. Quality of care for patients with STEMI was evaluated according to the quality criteria of the Association of Emergency Cardiovascular Care of the European Society of Cardiology. To compare the quality of care for patients of different age groups, the endpoints were the frequency of use of TLT and primary PCI, the incidence of cardiogenic shock, pulmonary edema, acute left ventricular aneurysm, and acute psychotic disorders. It is shown that patients with STEMI receive emergency medical care of high quality in adequate time. Elderly STEMI patients are less likely to undergo percutaneous coronary intervention, have more extensive myocardial damage with severe left ventricular failure and acute psychotic disorders, which is associated with a multiple increase in hospital mortality. The most frequent reasons for rejecting PCI were acute mental disorders, multivessel diffuse lesions of the coronary arteries with pronounced calcinosis, small diameter of the artery. It is necessary to develop new devices or techniques for PCI in conditions of severe multivessel lesions of coronary arteries with pronounced calcification, and also develop methods of neuroprotection in order to overcome existing barriers in providing emergency high-tech medical care to elderly STEMI patients.
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Indah, Aprila Aqmarina, Praditya Virza Ramadhan, Vireza Pratama, Haikal Haikal y Irnizarifka Irnizarifka. "Acute Coronary Syndrome in Well Trained Young Adult: A Rare Cases". Cardiovascular and Cardiometabolic Journal (CCJ) 1, n.º 2 (19 de septiembre de 2020): 69. http://dx.doi.org/10.20473/ccj.v1i2.2020.69-76.
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Acute Coronary Syndrome (ACS) has been observed in the older population (>40 years old), sedentary lifestyle and unhealthy behaviour. Recently, there is an increase of ACS reported in the younger population even without a sedentary lifestyle.We report a case of awell-trained 25-years old man thatcame with late presentation of ST elevation myocardial infarction (STEMI) occurred 10 minutes after vigorous exercise. His traditional risk factor was a smoker.Electrocardiogram (ECG) showed a pathological Q wave in V1-V3 and T wave inversion in V1-V6 with elevated cardiac biomarker. Primary percutaneous coronary intervention (PPCI) was performed due to prolonged chest pain and it showed subtotal occlusion in mid left anterior descending artery (LAD) with high thrombus burden. One drug eluting stent (DES) was implanted at mid LAD and GPIIb/IIIa inhibitor and low molecule weight heparin was given with good clinical result.
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George, Jisa y Malathy A.R. "Efficacy of Quantitative Troponin I in Predicting Cardiovascular Outcome in ST Segment Elevation Myocardial Infarction / Non-ST Segment Elevation Myocardial Infarction (STEMI / NSTEMI) Patients - A Retrospective Study from a Centre in South India". Journal of Evidence Based Medicine and Healthcare 8, n.º 14 (5 de abril de 2021): 877–81. http://dx.doi.org/10.18410/jebmh/2021/171.
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BACKGROUND Cardiac biomarkers like troponin play a very important role in the diagnosis of acute myocardial infarction. In a developing country like India, though the burden of cardiovascular diseases is on the rise, majority of the patients with acute coronary syndrome do not have access to primary percutaneous coronary intervention (PCI) facilities. Few Indian studies have looked into the utility of the quantitative troponin levels in predicting the cardiovascular outcome of non-ST segment elevation myocardial infarction / ST segment elevation myocardial infarction STEMI / NSTEMI patients; this study was conducted to find out the same. METHODS A retrospective analysis of the medical records of intensive care units (ICU) patients more than 18 years of age admitted with diagnosis of STEMI / NSTEMI for a duration of 12 months was done. The comorbidities, treatment, coronary artery disease (CAD) risk factors, cardiovascular complications and quantitative troponin levels were noted. RESULTS Retrospective analysis of 124 patient records was done which revealed that 74.8 % presented with STEMI and the rest were diagnosed to have NSTEMI. 39.5 % were hypertensive and 47 % were diabetic. The mean troponin values were higher in the patients who died and developed cardiac complications like left ventricular failure and cardiogenic shock. However, statistical significance was seen only for troponin values and left ventricular failure (LVF). CONCLUSIONS The quantitative levels of a simple biomarker like troponin I used for the diagnosis of acute myocardial infarction could also be used to predict the cardiovascular outcome and prognosis of the patient. A higher baseline troponin value during the diagnosis could possibly alert the treating primary physician for a referral to a specialised cardiac centre and likely need for early revascularisation, which is of importance in a developing country like India with compromised resources. KEYWORDS Quantitative Troponin I, STEMI, NSTEMI
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Kadloor, Parvaiz, Mohammed Hidayathullah y Abhishek Golla. "Reduced left ventricular ejection fraction in patients with acute coronary syndrome as a risk factor for mortality". International Journal of Research in Medical Sciences 10, n.º 1 (28 de diciembre de 2021): 80. http://dx.doi.org/10.18203/2320-6012.ijrms20215035.
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Background: The study aimed to evaluate left ventricular ejection fraction (LVEF) as the risk factor for mortality in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI).Methods: This was an observational, single centre study. The patients who were admitted at tertiary care centre in India during the period February 2014 to June 2015 who were diagnosed with ACS were included in the study. The patients were evaluated by dividing into two groups based on LVEF. The patients were followed up to 1 year.Results: Total 100 patients were included in the study. Chest pain was the most prevalent complaint (60%). Seventy patients presented with STEMI (ST-segment elevation myocardial infarction) and 30 with NSTEMI (non-ST-segment elevation myocardial infarction). Seventy five patients had ejection fraction ≥40% and 25 patients had reduced ejection fraction. Reduced LVEF did not show any statistical difference in patients with presentation as STEMI and NSTEMI or need for revascularisation. At year follow up, total 9 patients died. However, reduced LVEF led to statistically higher deaths (p<0.05%).Conclusions: In our study it was observed that patients with ACS complicated by heart failure with reduced ejection fraction have a markedly increased short- and long-term mortality rates compared to ACS patients without heart failure.
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Kohan, Marío R., Virginia Messler, Horacio Buffa, Rubén Fernández, Luciano M. Fernández Estaiye, Julio G. Pachado, Lorena Brocal Ocampo, Vanina B. Cremaschi, Marcos A. Mayer y Gustavo Vera. "Reperfusion Times in a Telemedicine-guided Program for the Management of ST-segment Elevation Myocardial Infarction in the Province of La Pampa". Revista Argentina de Cardiologia 90, n.º 4 (agosto de 2022): 268–73. http://dx.doi.org/10.7775/rac.v90.i4.20536.
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Background: Timing of medical care is a relevant factor for ST-segment elevation myocardial infarction (STEMI) mortality. Objectives: The aim of the present study is to evaluate reperfusion times in STEMI patients participating in a telemedicine-based cardiology care program in the province of La Pampa between August 2018 and December 2021. Methods: This program consists of a protocol for the management of patients with acute coronary syndrome (ACS) in the different locations of the province, with 24-hour remote assistance provided by cardiologists, including both diagnostic support and coordination of on-site thrombolysis. Results: Of a total of 72 STEMI patients evaluated, 44 received thrombolysis as reperfusion therapy, 25 received primary percutaneous coronary intervention, and 3 received thrombolysis followed by rescue percutaneous coronary intervention. Of the 47 subjects who received thrombolysis, only 5 required to be transferred to the referral center for this procedure. Median door-to-needle time was 24 minutes and door-to balloon-time was 105 minutes. Twenty-eight percent of the subjects with primary percutaneous coronary intervention had a door-to-balloon time < 90 minutes and 53.2% of patients who received thrombolysis fulfilled a door-to-needle time < 30 minutes. Conclusions: The implementation of a telemedicine-guided program for decentralized management of STEMI patients was associated with a high percentage of compliance with the goals of implementing fibrinolytic-based reperfusion therapy
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Maharjan, Prabindra, Reezu Manandhar, Wei Xu, Shuting Ma, Wenqi Han, Yan Liu, Yuan Zhou, Yue Wu, Caofeng Sun y Zuyi Yuan. "Markers of Autolysis in Acute ST Elevation Myocardial Infarction – A Comparative Analysis". Journal of Nepal Medical Association 53, n.º 198 (30 de junio de 2015): 96–103. http://dx.doi.org/10.31729/jnma.2769.
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Introduction: The availability of reliable noninvasive markers for infarct-related artery patency status are very limited, otherwise could allow early identification of patients with patent IRA, for whom repeat thrombolysis or rescue percutaneous coronary intervention are not necessary.
Methods: We conducted a single centered retrospective study of STEMI patients undergoing primary PCI to determine how various factors such as demographic characteristics, risk markers of coronary heart disease, clinical and blood parameters present differently in patients with higher coronary flow and patent infarct related artery from patients with total occlusion at the time of initial angiography and how they affect in outcome of the disease.
Results: MPV level (11.96 fL vs. 10.92 fL, P < 0.001), Lp (a) level (179.57 nmol/l vs 141.16 nmol/l , p < 0.001), CK-MB (290.2 vs. 190.98, P < 0.001), total cholesterol level (4.11 mmol/L vs. 3.8 mmol/L, p < 0.02) in total occlusion group were higher than in the patent IRA group. Wall motion abnormality was 77.2% for 203 patients with total occlusion group and 54.2% for 83 patients with patent IRA group (P<0.01). Mean hospital stay days were higher in total occlusion group as compared to the patent IRA group P < 0.01.
Conclusions: MVP, Lp (a), TC, and CK-MB levels and myocardial wall motion at the presentation may play the role of markers for IRA patency status that will help in early identification of patients with IRA, for whom repeat thrombolysis or rescue PCI may not be required.
Keywords: acute coronary syndrome; infarct related artery; myocardial infarction.
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Rakowski, Tomasz, Dariusz Dudek, Arnoud van ’t Hof, Jurrien Ten Berg, Louis Soulat, Uwe Zeymer, Frederic Lapostolle et al. "Impact of acute infarct-related artery patency before percutaneous coronary intervention on 30-day outcomes in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention in the EUROMAX trial". European Heart Journal: Acute Cardiovascular Care 7, n.º 6 (20 de febrero de 2017): 514–21. http://dx.doi.org/10.1177/2048872617690888.
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Aims: Early infarct-related artery patency has been associated with improved outcomes in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. However, it is unknown whether this relationship persists in contemporary practice with pre-hospital initiation of treatment, use of novel P2Y12 inhibitors and frequent use of drug-eluting stents. The purpose of the study was to determine the impact of early infarct-related artery patency on outcomes in the contemporary EUROMAX trial. Methods and results: A total of 2218 patients were enrolled. The current analysis was done on 1863 patients who underwent percutaneous coronary intervention and had infarct-related artery patency data. Thirty-day outcomes were compared according to infarct-related artery flow before percutaneous coronary intervention (Thrombolysis in Myocardial Infarction (TIMI) flow 0/1 vs. TIMI flow 2/3), and interaction with antithrombotic strategy was examined. A patent infarct-related artery (TIMI flow 2/3) was present in 707 patients (37.9%) and was associated with a higher rate of final TIMI 3 flow grade (98.9 vs. 92.6%; p<0.001). At 30 days, a patent infarct-related artery was associated with lower rates of cardiac death (1.3% vs. 2.9%; p=0.026) and the composite of death or myocardial infarction (2.7% vs. 4.6%; p=0.039). There were no interactions between antithrombotic treatment and the impact of infarct-related artery patency on cardiac death, myocardial infarction, or the composite of death or myocardial infarction (Breslow–Day interaction p-values of 0.21, 0.33 and 0.46, respectively). Conclusion: Despite evolution in primary percutaneous coronary intervention strategies, early infarct-related artery patency is still associated with higher procedural success and improved clinical outcomes. The choice of antithrombotic strategy did not interact with the benefits of a patent infarct-related artery at presentation.
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Flores-Salinas, Héctor E., Fidel Casillas-Muñoz, Yeminia Valle, Cesar M. Guzmán-Sánchez y Jorge Ramon Padilla-Gutiérrez. "Good Practices in the Clinical Management of Patients with Acute Coronary Syndrome: Retrospective Analysis in a Third-Level Hospital in Mexico". Cardiology Research and Practice 2020 (6 de julio de 2020): 1–7. http://dx.doi.org/10.1155/2020/9624283.
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Introduction and Objective. In Mexico, there has been an increase in the risk of cardiovascular disease due to rising life expectancy, westernized lifestyle, lack of prevention, and industrialized exposure. This article describes the pharmacological treatment, surgical interventions, and associated clinical complications in patients diagnosed with acute coronary syndrome (ACS) and their impact on in-hospital mortality frequency in a Cardiology Unit in Instituto Mexicano del Seguro Social. Methods. This is a retrospective study including male and female patients aged ≥18 years who were diagnosed with ACS. The collected data included demographic characteristics, risk factors, medications, electrocardiograms, surgical procedures, and in-hospital deaths. Results. There are at least 20% more diagnoses of ST-segment elevation myocardial infarction in this hospital compared to the latest national reports in Mexico. The most common risk factors were type 2 diabetes mellitus, hypertension, smoking, and dyslipidaemia. Diabetic patients with a clinical history of percutaneous coronary intervention had a higher risk of non-ST-segment elevation myocardial infarction than nondiabetics (OR: 2.34; p=0.013), also smoking patients with previous heart surgery than nonsmokers (OR: 7.73; p=0.0007). The average in-hospital mortality was 3.6% for ACS. Conclusions. There is a higher percentage of coronary interventionism and improvement in pharmacological treatment, which is reflected in lower mortality. The substantial burden of T2DM could be related to a higher number of cases of STEMI. Diabetics with precedent percutaneous coronary intervention and smokers with previous heart surgery have an increased risk of subsequent infarction.
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Berbis, Julie, Marc Laine, Sébastien Armero, Jacques Bessereau, Laurent Jacquin, Caroline Bonello, Elise Camillieri et al. "Biological efficacy of a 600 mg loading dose of clopidogrel in ST-elevation myocardial infarction". Thrombosis and Haemostasis 108, n.º 07 (2012): 101–6. http://dx.doi.org/10.1160/th12-02-0125.
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SummaryOptimal platelet reactivity (PR) inhibition is critical to prevent thrombotic events in primary percutaneous coronary intervention (PCI). We aimed to determine the relationship between high on-treatment platelet reactivity (HTPR) and ST-elevation myocardial infarction (STEMI) following a 600 mg loading dose (LD) of clopidogrel. We performed a prospective monocentre study enrolling patients on clopidogrel undergoing PCI. The VASP index was used to assess PR inhibition after clopidogrel LD. HTPR was defined according to the consensus as a VASP index ≥50%. The present study included 833 patients undergoing PCI. Most patients had PCI for an acute coronary syndrome (58.7%). The mean VASP index was 50 ± 23% with a large inter-individual variability (range: 1–94%). Patients with a VASP index ≥50% were significantly older (p= 0.03), with a higher body mass index (BMI) (p<0.001), more often diabetic (p=0.03), taking omeprazole (p=0.03), admitted for an acute coronary syndrome (ACS) and with a high fibrinogen level compared to good responders (VASP <50%). In multivariate analysis BMI, omeprazole use, ACS and high fibrinogen level (p<0.001) remained significantly associated with HTPR. Of importance, in this analysis STEMI was independently associated with HTPR when compared with the other forms of ACS (NSTEMI and unstable angina) with an odd ratio of 2.14 (95% CI: 1.3 –3.5; p=0.003). In conclusion, STEMI is associated with high on-treatment platelet reactivity following 600 mg of clopidogrel. The present results suggest that 600 mg of clopidogrel may not be able to achieve an optimal PR inhibition in STEMI patients undergoing PCI and more potent drugs may be preferred.