Abstract Acute Myocardial Infarction Research Articles

OUTCOMES OF ACUTE MYOCARDIAL INFARCTION IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY: A UNITED STATES POPULATION-BASED STUDY

Acute myocardial infarction (AMI) is a recognized complication in patients with hypertrophic cardiomyopathy (HCM). However, there are limited data on outcomes of HCM patients presenting with AMI. We queried the 2003-2011 Nationwide Inpatient Sample databases to identify all patients ≥18 years

Mean platelet volume in acute myocardial infarction: a case-controlled study

Abstract Acute myocardial infarction (AMI) is a common emergency which requires timely intervention. Traditionally, its diagnosis is based on symptoms, electrocardiogram and cardiac biomarkers. Symptoms may be nonspecific.

Percutaneous coronary intervention for acute myocardial infarction due to unprotected left main coronary artery occlusion: status update 2014.

Acute myocardial infarction (AMI) due to unprotected left main coronary artery (ULMCA) occlusion is an uncommon clinical entity, but often leads to severe clinical deterioration, with devastating sequalae including fatal arrhythmias, abrupt and severe circulatory failure, and sudden cardiac death. Recent guidelines have promoted treatment with percutaneous coronary intervention (PCI) as a class IIa recommendation alongside coronary artery bypass grafting (CABG), but the data are still unclear regarding optimal revascularization strategy for patients with ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) with ULMCA culprit. PCI has the advantages of offering rapid reperfusion to critically ill patients, often those with prohibitive risk for surgical revascularization, with acceptable short- and long-term outcomes. Recent studies demonstrate that PCI of the ULMCA is a viable alternative to CABG for appropriate patient populations, including those with ULMCA occlusion and those in cardiogenic shock, Thrombolysis In Myocardial Infarction (TIMI) flow grade 3, and significant comorbidities. A randomized trial comparing PCI with CABG is needed to clarify the ideal revascularization strategy, though the clinical picture of these critically ill patients may preclude such studies.

Abstract 336: Cardiac Function Improvement in Infarcted Rats Treated with an Association of N-acetylcysteine and Deferoxamine

Acute myocardial infarction (AMI) is followed by free radicals generation, which is central in cardiac remodeling. N-acetylcysteine (NAC) is an antioxidant that may have pro-oxidant activity in presence of iron ions. Thus, the association with an iron chelator might improve NAC antioxidant potential. Our aim was to test the association of NAC and an iron chelator (deferoxamine - DFX) on cardiac remodeling in a rodent model of AMI. To this end, Male Wistar rats (60 days old) were subjected to a sham surgery or subjected to myocardial infarcted by the occlusion of left ventricular descending artery. Twelve hours after, AMI was confirmed by cTnI evaluation and the animals were randomized in the following treatments: vehicle, NAC (25 mg/kg for 28 days), DFX (40 mg/kg for 7 days), or NAC plus DFX (NAC 25 mg/kg for 28 days plus DFX 40 mg/kg for 7 days). All animals were followed for 28 days. AMI induced an increase in total plasma iron levels at 7 days after the procedure and all treatments were able to decrease iron concentration. NAC/DFX was able to keep iron levels low up to 28 days. Morphofunctional assessments were made serially by echocardiography. Animals treated with NAC/DFX showed an increase in ejection fraction at 28 days when compared with vehicle group (45% ± 11% vs. 35% ± 9%,respectively; p=0.03). On histological analysis (at 28 days), NAC/DFX treated rats showed decreased oxidative stress (immunohistochemistry anti-4-hydroxynonenal, a side product of lipid peroxidation) when comparing with vehicle group (p=0.059). In conclusion, the association of NAC/DFX was able to attenuate chamber remodeling and improved left ventricle function in an animal model of AMI, whereas either NAC or DFX had no effect when given alone. The likely participation of iron and free radicals can be suggested, but further studies are necessary.

TRENDS IN CHARACTERISTICS, TREATMENT AND OUTCOMES AMONG PATIENTS WITH ACUTE MYOCARDIAL INFARCTION IN CHINA FROM 2001 TO 2011

Acute myocardial infarction (AMI) is responsible for a substantial and growing burden of death and disability in China. However, there is little information on trends of patient characteristics, treatment, and patient outcomes. We collected a nationally representative sample of patients with AMI

THE CHINA ACUTE MYOCARDIAL INFARCTION REGISTRY: A NATIONAL REGISTRY-QUALITY IMPROVEMENT INTEGRATED PROGRAM IN CHINA

Acute myocardial infarction (AMI) is now a major cause of emergency medical care, hospitalization and mortality in China. However there are limited information on how clinical characteristics, care quality and outcome vary among Chinese patients and hospitals. We launched the China AMI (CAMI)

“Of coronary arteries and men”: the fight of a dialysis patient against his coronary arteries

Acute myocardial infarction (AMI) in dialysis patients is associated with high mortality rate. Large randomized controlled trials documenting the benefits of revascularization in the general population have excluded chronic dialysis patients. Few observational data suggest that revascularization may provide a survival benefit compared with medical treatment alone also in these patients. We report a case of a dialysis patient who survived five documented AMIs, underwent five coronary angiographies in 11 years, had several episodes of angina pectoris and underwent percutaneous transluminal coronary angioplasty (PTCA) with stenting and heart surgery for coronary bypassing. It represents a highly unusual therapeutic approach and might contribute to support also in dialysis patients the use of revascularization to improve survival.

Monitoring the Sequelae of Coronary Microembolization on Myocardium Using Noninvasive Imaging (Review)

Acute myocardial infarction (AMI) is a leading cause of death worldwide. It has been clinically classified into 1) ischemic from a primary coronary event (e.g., plaque rupture or thrombotic occlusion), 2) ischemic from a supply-and-demand mismatch and c) ischemic from a percutaneous coronary interventions (PCI). Catheter-based PCI has been frequently used as an alternative to conventional bypass surgery for patients at high risk. However, this method of treatment is associated with microvascular obstruction (MVO) by dislodged microemboli that results in left ventricular (LV) dysfunction/remodeling, perfusion deficits, microinfarction and arrhythmia. The contributions of microemboli after revascularization of AMI have been acknowledged by major cardiac and interventional societies. Recent studies showed that Emboli Detection and Classification (EDAC) Quantifier offers increased sensitivity and capability for detecting dislodged coronary microemboli during PCI. Coronary microembolization can be detected directly by monitoring intra-myocardial contrast opacification on contrast echocardiography, increasing F-18 fluorodeoxyglucose (FDG) uptake on positron emission tomography, loss/diminution of signal on first pass perfusion and hypoenhanced zone on contrast enhanced magnetic resonance imaging (MRI) and multidetector computed tomography (MDCT) and indirectly by ST-segment elevation on electro-cardiography (ECG). The relations between volumes/sizes of microemboli, visibility of microinfarct, myocardial perfusion and LV function are still under intensive discussions. Non-invasive imaging can play important role in assessing these parameters. This review shed the light on the techniques used for detecting coronary microemboli, microvascular obstruction and microinfarct and the short- and long-term effects of microemboli on LV function, structure and perfusion.

Pregnancy-associated myocardial infarction

Acute myocardial infarction (AMI) is a rare, but possibly catastrophic event during pregnancy, delivery, or puerperium, leading to a high mortality rate. It has different pathogenic mechanisms, such as atherosclerosis, vasospasm, thrombosis, and coronary dissection. Although MI has been reported in pregnant women at all stages of pregnancy and postpartum, it occurs more commonly in the third trimester. Pregnancy-associated MI most commonly involves the anterior wall. Pregnancy itself is an independent risk factor for MI, conferring a fourfold higher risk than that of nonpregnant women matched for age. We report the case of a 27-year-old primigravida at 30weeks' gestation presenting with anterior MI, secondary to severe stenosis of the left anterior descending coronary artery, treated with emergency percutaneous coronary intervention.

Complicaciones del infarto de miocardio. Medidas terapéuticas

Acute myocardial infarction (AMI) is a severe clinical entity, which is life-threatening in a short term and which increases morbimortality in a medium-long term. That is because of a serie of complications related to the AMI. We can make a classification of these complications, depending on their nature, into: arrhythmic, mechanical, and complications derived from muscle dysfunction (which means heart failure). With the increase in the provision of prompt and effective reperfusion therapy, the incidence of AMI related complications has fallen. In any case, the early detection of the symptoms and signs of these situations would allow us to perform an appropriate managment of the patient.

ANTI-PHOSPHATIDYLSERINE ANTIBODIES IN ACUTE MYOCARDIAL INFARCTION

Acute Myocardial Infarction (AMI) is the combined result of environmental factors and personal predispositions. Many factors play a role in AMI in cluding anti-Phospholipid (aPL) antibodies, that may act in the induction of immunological response leading to the development of AMI. AntiPhosphatidylserine (PS) antibody is detected in var ious diseases like rheumatoid arthritis, systemic lupus erythematosus and anti-phospholipid antibody syndrome. The study of anti-PS antibody in AMI might shed light on etiologic mechanisms in the pat hogenesis of acute coronary syndromes. This study was conducted to evaluate whether prevalence of ant i-PS antibodies, in patients who had AMI and to analyze their relationship with traditional cardiov ascular risk factors. The prevalence of anti-PS IgG and IgM in a well characterized group of patients w ith AMI as a case group and in age and sex matched healthy subjects as control group. Sera fro m two groups were tested to evaluate the presence of IgG and IgM isotypes to anti-PS by ELISA method. The frequencies of positive test for anti-PS IgG were 26.70 and 8.90% among patients and controls re spectively with significant difference (p = 0.003). The anti-PS IgM frequencies were 12.20 and 1.10% in patients and the controls, with significant difference (p = 0.005). The findings of this study suggest that anti-PS antibodies seemed to play a ro le in AMI, independent risk factors for AMI, which may represent a link between autoimmunity and atherosclerosis in patients with AMI. Further studi es with bigger sample size including patients with AMI and healthy people are recommended to explore the exact role of anti-PS antibodies in AMI.

ACUTE MYOCARDIAL INFARCTION AND IN-HOSPITAL MORTALITY AFTER CARBON MONOXIDE POISONING: AN ANALYSIS OF THE NATIONWIDE INPATIENT SAMPLE 2002–2010

Acute myocardial infarction (AMI) and in-hospital mortality rates following Carbon monoxide (CO) poisoning have not been studied in a national database. All hospitalized patients age ≥18 years included in the nationwide inpatient sample (NIS) 2002–2010 databases with a confirmed diagnosis of CO

Prompt Recognition and Percutaneous Coronary Intervention Leads to Favorable Myocardial Recovery After ST-Segment Elevation Myocardial Infarction Secondary to Acute Promyelocytic Leukemia: Pediatric Case Report

Acute myocardial infarction (AMI) is extremely rare in children, and unlike the adult disease, the etiology of the infarction is rarely due to atherosclerotic coronary disease. This unique reported case involved a 15-year-old boy with severe chest pain who presented with an ST-segment-elevation myocardial infarction secondary to in situ thrombus formation in the left anterior descending (LAD) coronary artery. The initial electrocardiogram (ECG) had a Q-wave pattern in V6 and ST depression in the inferior leads with ST-segment elevation in reciprocal leads. The cardiac enzymes and routine labs showed evidence of myocardial damage. The boy was urgently taken to the cardiac catheterization laboratory for percutaneous coronary intervention, where complete occlusion of the LAD was found and successfully stented. Eventually, a peripheral blood smear showed pancytopenia with 38 % hypergranular blast-like cells consistent with acute myeloid leukemia (AML), and chemotherapy with all-transretinoic acid was implemented. This first pediatric case report of an AML-associated AMI emphasizes the benefit resulting from expedient reperfusion of the ischemic myocardium by quick reestablishment of coronary perfusion. It also emphasizes the limitations of existing noninvasive technologies in detecting myocardial viability.

Dramatic changes in catestatin are associated with hemodynamics in acute myocardial infarction

Acute myocardial infarction (AMI) is characterized by complex neuroendocrine activation. To investigate catestatin profiles, serial catestatin levels were determined by enzyme-linked immunosorbent assay in the first week after AMI in 50 patients. Catestatin levels reduced at admission and negatively correlated with heart rates; it increased significantly on the third day but remained decreased at 1 week and positively with blood pressure. In a subgroup of 20 patients admitted within 4 h after onset, circulating catestatin correlated inversely with norepinephrine. Catestatin might be involved in the course of AMI and act as a tool in monitoring the progression of AMI.

Thrombectomy with rescue aspiration catheter and distal protection with EPI filterwire in primary angioplasty for acute myocardial infarction

AMI (Acute Myocardial Infarction) is usually caused by abrupt plague rupture followed by thrombus formation inside the coronary artery. Primary angioplasty for heavy thrombus loaded vessels may be complicated by distal embolization, leading to no reflow and myocardial damage. We present a case of acute thrombotic occlusion of the left anterior descending artery (LAD), in which we performed simultaneous thrombus removal by the rescue aspiration thrombectomy catheter together with an EPI FilterWire for distal protection against embolization. The lesion was successfully stented with excellent perfusion to the distal capillaries. A huge load of debris (red and white) was retrieved by both devices. The patient remained asymptomatic at 9 months. This case illustrates the possible DUAL protective roles of Aspiration Thrombectomy and Filtering devices in high risk angioplasty for AMI patients.

Diagnosis of Acute Myocardial Infarction Using Highly Sensitive Cardiac Troponin Assays

Acute myocardial infarction (AMI) is a major cause of morbidity and mortality worldwide. Determining the level of cardiac troponins (cTn), structural proteins unique to the heart, is a cornerstone of AMI diagnosis. One important limitation of standard cTn assays is a sensitivity deficit at presentation due to a delayed increase of circulating cTn levels. Recent multicentre studies have shown that novel, more sensitive and more precise cTn assays improve the early diagnosis of AMI. cTn must be interpreted as a quantitative variable. ‘Detectable’ levels will become the standard and must be clearly differentiated from ‘elevated’ levels. The differential diagnosis of a small amount of cardiomyocyte necrosis and, therefore, mild elevation of cTn, is broad and includes acute and chronic disorders. The differential diagnosis of more extensive cardiomyocyte necrosis, and therefore substantial elevation of cTn, is much smaller and largely restricted to AMI, myocarditis and Tako-Tsubo cardiomyopathy.

Fibrinólisis en infarto agudo de miocardio en el servicio de urgencias de un hospital comarcal

Acute myocardial infarction (AMI) is caused by a lack of blood supply due to obstruction of a coronary artery causing ischaemia around the heart muscle. The patient with AMI usually begins with chest pain, which is sometimes irradiating and oppressive, but this is not always decisive, as we will see. It can be detected rapidly, or suspicion confirmed by performing an ECG, which in most cases will show changes in the ST segment. The diagnosis can be supplemented by an analytical study with specific values of creatine kinase and Troponins. Due to the long distances that there may be between a level I hospital and a level III one, where in many cases, to obtain fibrinolytic treatment. This treatment involves administering a fibrinolytic drug to dissolve the clot that clogs the coronary artery causing the heart attack. The door-needle time (defined as the time between when the patient enters the emergency department to having the first puncture for treatment) is very important as the longer the time of onset of AMI, fibrinolytic treatment may be contraindicated. The performing of nursing triage may be critical for this health problem. Nursing care will also be the key for patient care.

Appraisal of the prognosis in patients with acute myocardial infarction treated with primary percutaneous coronary intervention

Acute myocardial infarction (AMI) is still the leading factor causing crippling and death in cardiovascular disease. Percutaneous coronary intervention (PCI) can significantly reduce inpatient mortality and incidence of complication. But owing to the existence of restenosis, in-stent thrombosis, etc., recurrent post-PCI cardiovascular events and high repeatability of hospitalization, as well as its crippling rate and mortality, remain a serious threat to the society and the patients' family. Therefore, the appraisal and intervention in post-PCI associated risk factors has presently become one of the foci in clinical research. To improve the near- and long-term prognosis and quality of life in post-PCI AMI patients, further improvement of the evaluation system in risk factors and prognosis is necessary in order to provide a theoretical basis for early application of intervention in high-risk patients in clinical practice. This thesis mainly dissertates some explicit and valuable factors for clinical prognosis evaluation in recent studies, involving C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-alpha), brain natriuretic peptide (BNP), atrial natriuretic peptide (ANP), Chinese medicine (TCM) syndrome, their correlation with clinical state and course of AMI, and their importance in clinical prognosis.

Clinical Application of a Novel Self-expanding Coronary Stent in Acute Myocardial Infarction

Acute myocardial infarction (AMI) is a severe coronary condition with potentially fatal consequences. Currently, the standard of care is to perform thromboaspiration followed by stent implantation as part of percutaneous coronary intervention. However, due to the thrombus load and vasoconstriction of the artery during the procedure, there is a tendency to underestimate vessel size, resulting in selection of a stent that will be smaller than the artery after clot resolution and vasodilation. This potentially increases the risk of stent malapposition and subsequent stent thrombosis. A novel self-expandable stent was recently developed; preliminary results from the APPOSITION I study demonstrate its feasibility in the treatment of AMI and its ability to follow the enlargement of the artery with near perfect apposition. This self-expandable stent may therefore become an important tool in the treatment of AMI.

Study of risk factors for female patients with acute myocardial infarction

Acute myocardial infarction (AMI) is one of the most common cardiovascular emergencies. Female patients have different features to male patients. The objective of our study was to analyze risk factors for female patients with AMI.