Acute ST Myocardial Infarction Research Articles

Abstract 2099: Coronary Artery Thrombosis Due To Intramural Hematoma

BJMC ,male 61 years old, presented with acute chest pain and non ST acute myocardial infarction. ECG showed ST segment depression on anterior and lateral precordial leads and ST elevation on aVR. Ultra-sensitive Troponin T rised . Coronary angiography showed calcified Left main(LM) with critical lesion extending to anterior descending artery. Percutaneous Coronary Intervention (PCI) was performed succesfully with stent implantation. Two hours later he started with epigastric discomfort , anxiety ,chest pain , diaphoresis , tachycardia and acute ECG changes , irresponsive to intravenous nitroglycerin . He evolved to ventricular tachycardia and cardiac arrest , with CPR. New PCI was followed with immediate clinical improvement . Clinical symptoms of ischemia and hemodynamic instability were due to significant (LM) caliber reduction .IMH is a pathological process were blood accumulate within the media space, suggesting new stenosis or spasm. IMH is unfrequent - may occur in initial hours and even at several days after apparently succesfull intervention. IMH causes acute lumen obstruction and thrombosis. The diagnosis is frequently missed and the clinical course can be dramatic and life threatening. Intravascular ultrasound (IVUS) is a very importante tool to identify IMH and should be available in complex cases interventions.

Coronary artery aneurysm presenting as ST-elevation myocardial infarction in a man with coronavirus disease 2019: a case report

BackgroundPatients with underlying cardiovascular risk factors have worse clinical outcomes when they have coronavirus disease. In addition, a reduced workload of cardiovascular emergencies has been reported during the coronavirus pandemic due to patients’ reluctance to attend hospitals for fear of contracting the disease. Regional health service reorganization, separating hospitals into coronavirus and non-coronavirus can mitigate this effect. However, the effectiveness of this approach on outcomes and patient satisfaction is unknown.Case presentationA 35-year-old Pakistani man with acute ST myocardial infarction was found to have thrombosis of the right coronary artery aneurysm and concomitant coronavirus disease. He had percutaneous coronary angiography and thrombus removal, and was transferred to a coronavirus hospital for the management of the infection. Due to the large size of the aneurysm, he was considered for surgical intervention. Following discharge from the coronavirus hospital and a period of stay at the isolation center, he failed to keep his cardiology follow-up appointment.ConclusionThis case illustrates an unusual cause of myocardial infarction in a patient with coronavirus infection whose care may have been adversely affected by the healthcare system restructuring.

Untargeted metabolomics identified kynurenine as a predictive prognostic biomarker in acute myocardial infarction.

The occurrence of cardiovascular adverse events in the first year after ST-acute myocardial infarction (STEMI) remains high; therefore, identification of patients with poor prognosis is essential for early intervention. This study aimed to evaluate the prognostic value of metabolomics-based biomarkers in STEMI patients and explore their functional mechanisms. Metabolite profiling was performed using nuclear magnetic resonance. The plasma concentration of Kynurenine (Kyn) was measured using ultraperformance liquid chromatography/electrospray ionization quadruple time-of-flight mass spectrometry. Major adverse cardiac and cerebral events were assessed for 1 year. A functional metabolomics strategy was proposed for investigating the role of Kyn in both vitro and vivo models. The adjusted hazard ratios in STEMI patients for Kyn in the 4th quartile 7.12(5.71-10.82) was significantly higher than that in the 3rd quartile 3.03(2.62-3.74), 2nd quartile 1.86(1.70-2.03), and 1st quartile 1.20(0.93-1.39).The incidence of MACCE was significantly different among Kyn quartiles and the highest incidence of MACCE was observed in the 4th quartile when compared with the 1st quartile (9.84% vs.2.85%, P<0.001).Immunofluorescence staining indicated that indoleamine-pyrrole 2,3-dioxygenase (IDO1) was located in the CD68 positive staining area of thrombi from STEMI patients and Kyn was induced in the early phase after myocardial infarction. Kyn could trigger inflammation and oxidative stress of macrophage cells by activation of the Sirt3-acSOD2/IL-1β signaling pathway in vitro. Plasma Kyn levels were positively associated with the occurrence of STEMI. Kyn could induce macrophage cells inflammation and oxidative stress by activating the Sirt3-acSOD2/IL-1β pathway following myocardial ischemia injury. Kyn could be a robust biomarker for STEMI prognosis and reduction of Kyn could be beneficial in STEMI patients.

Genetic Polymorphisms Associated with Thrombotic Disease Comparison of Two Territories: Myocardial Infarction and Ischemic Stroke.

Background and Purpose The thrombin-activatable fibrinolysis inhibitor (TAFI) is an important inhibitor of fibrinolysis and plays a critical role in the pathogenesis of arterial thrombosis; genetic polymorphisms of the TAFI gene affect its activity and increase the risk of thrombosis. Moreover, studies in young patients are still scarce. The aim was to examine the contribution of the Thr325Ile and Ala147Thr polymorphisms with ST acute myocardial infarction (STEMI) or idiopathic ischemic stroke (IIS) in the young Mexican population. Methods A total of 244 patients with STEMI ≤45 years of age and 244 controls. In a second study, 250 patients with IIS ≤45 years of age were recruited, including 250 controls. In both studies, cases and controls were matched by age and sex. The polymorphisms were determined in all participants by PCR-RFLP. Results There was significant difference in the Thr325Ile genotype distribution (P = 0.001) and allele frequency (P = 0.001) between STEMI and control groups, but no difference in the Ala147Thr genotype distribution (P = 0.24) and allele frequency (P = 0.46), neither in the Thr325Ile genotype distribution (P = 0.25) nor in the Ala147Thr genotype distribution (P = 0.46) or their allele frequencies; there was significant difference between IIS and the control group. There were independent factors for STEMI: the Ile allele (P = 0.01), type 2 diabetes mellitus (P = 0.001), hypertension (P = 0.001), smoking (P = 0.001), dyslipidemia (P = 0.001), and family history of atherothrombotic disease (P = 0.001). The independent factors for IIS were hypertension (P = 0.001), smoking (P < 0.01), and family history of atherothrombotic disease (P < 0.01). Conclusions The Thr325Ile polymorphism, but no Ala147Thr polymorphism, represents an independent risk factor for STEMI in the young Mexican population.

Reteplase in treatment of acute ST elevation myocardial infarction: clinical study of 245 cases

Objective To investigate the clinical efficacy and safety of Reteplase in the treatment of acute ST segment elevation myocardial infarction(STEMI) with different onset time. Methods The clinical data of 245 patients with STEMI who received Reteplase thrombolytic therapy and the onset of the disease within 6h in the People's Hospital of Linyi County were retrospectively analyzed.According to the time of onset of the disease, the patients were divided into two groups.The onset of the disease in group 1 was less than 3h, that in group 2 was 3-6h.The recanalization rate, recanalization time, the incidence rate of bleeding and mortality were compared between the two groups. Results The recanalization rate of group 1 (94.63%) was higher than that of group 2(92.70%), but the difference was not statistically significant(χ2=3.80, P 0.05). The mortality of group 1 was 3.36%, which of group 2 was 3.12%, the difference was not statistically significant (P>0.05). Conclusion Reteplase for the STEMI patients with onset of the disease within 3h, the recanalization time is shorter than STEMI patients with onset of the disease 3-6h.The rate of recanalization is higher, and there is no significant difference in the rate of bleeding and in-hospital mortality. Key words: Myocardial infarction; Tissue plasminogen activator; Thrombolytic therapy

Application of ECG fragmentation QRS wave in the diagnosis of acute myocardial infarction

Objective To investigate the clinical value of fragmentation of QRS wave in the diagnosis of acute myocardial infarction. Methods A total of 83 patients with acute myocardial infarction diagnosed by coronary angiography in the First People's Hospital of Jiande were selected in the research (observation group), including 41 patients with acute ST elevation myocardial infarction(observation group A), 42 patients with non-ST elevation acute myocardial infarction(observation group B). And 80 healthy subjects were selected as control group.The changes of fragmented QRS wave were compared among three groups, the efficacy of fragmented QRS wave in the diagnosis of acute myocardial infarction were observed. Results The incidence rate of fragmented QRS wave in the observation group was 71.1%, which was significantly higher than 10.0% in the control group, the difference was statistically significant(χ2=12.541, P 0.05). Conclusion The fragmentation of QRS wave in the diagnosis of acute myocardial infarction has high application value, but also can not ignore the pathological Q wave function, the index can be used to diagnose the disease combined with clinical practice, help to improve the accuracy of diagnosis. Key words: Electrocardiography; QRS wave; Myocardial infarction; Diagnosis

Manejo ejemplar del infarto agudo de miocardio con la utilización de protocolos sofisticados de Telemedicina

IntroductionTelemedicine offers a powerful and cost-effective tool that uses scales in order to reduce the differences in the treatment of acute myocardial infarction between the developed and developing countries. MethodsA strategy was used, in which health centres in remote areas were strategically connected to clinics with 24/7 catheter laboratories. Experts in Bogota provided the electrocardiographic diagnosis and tele-consultation using the Latin America Telemedicine Infarct Network (LATIN), activating the sending of ambulances, and the implementation of the LATIN protocols. ResultsA total of 113 centres in Colombia were connected to a network covering a large segment of the population. Of the 110,823 patients examined, 1014 (1%) were diagnosed with an acute ST-myocardial infarction. A total of 472 (46%) of these patients were reperfused, with the majority (324, 68.6%) by means of percutaneous coronary intervention. The main reasons for non-treatment included refusal of medical insurance, lack of intensive care units, and chest pain> 12hours. The time to diagnosis was 5.5minutes with an accuracy of 98%. ConclusionsLATIN demonstrates the possibility of creating a strategy for treating acute myocardial infarction in a population base and guided by Telemedicine. This widens the access to emergency treatment in developing countries, where this acquires significant implications in public health, such as an overall approach to the urgent treatment of this condition.

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

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

Obtaining an 'informed' consent for primary percutaneous coronary intervention (PPCI) in non-English speaking patients…the dilemma.

To improve the informed consent process for non-English speaking patients requiring emergency PPCI. PPCI is the standard treatment of acute ST elevation myocardial infarction (STEMI). Obtaining an informed consent remains one of the main reasons for non-system-related delay in the door-to-balloon time.1 This problem is accentuated in a multi-ethnic society where some patients do not …

Study of serum uric acid levels in acute ST elevation myocardial infarction patients and its correlation with Killips classification of heart failure

Aims: To estimate serum uric acid levels in acute ST elevation myocardial infarction patients and its correlation with killips classification of heart failure.Methods : 100 Patients with Acute ST elevation myocardial infraction admitted between october 2011 to April 2013 were studied. Serum uric acid level was measured on day 0, 3 & 7 of MI. A detailed history and physical examination with reference to killips classification was carried out and correlated with serum uric acid levels.Statistical analysis: Data presented with mean + SD. Uric acid levels and killips class compared with spearman correlation coefficient. Results: The mean age of the patients was 58.43 + 13.77. The male to female ratio was 65:35 showing a male predominance. Mean uric acid levels on day 0 is 5.179 + 1.910, on day 3 is 5.0325 + 1.755, on day 7 is 4.953 + 1.446. Uric acid levels was compared with killip class on day 0 and it is found to be significant(r = 0.7374 and p 7mg/dl). 19 patients were in Killips class IV at the time of death. On all the days serum uric acid levels were higher in patients who were in higher Killip class.Conclusion: Patients with elevated serum uric acid levels belonged to higher killips classification and were associated with higher mortality. Hence we can use serum uric acid as an inexpensive cardiovascular risk marker and prognostic marker in MI patients.

The comparison of ticagrelor and clopidogrel on patients undergoing percutaneous coronary intervention with acute ST elevated myocardial infarction

Objective To compare the effects of ticagrelor and clopidogrel on patients undergoing percutaneous coronary intervention(PCI) with acute ST elevated myocardial infarction(STEMI). Methods 120 patients with STEMI received PCI within 12h of symptom onset in our hospital were randomly divided into clopidogrel treated group(n= 60)and ticagrelor treated group(n= 60). Serum was collected before surgery and 36 hours after PCI for ALT,Cr,CK- MB, and MA. Cardiac ultrasound was examined, too. All patients were followed 6 months post- PCI for main adverse cardiovascular and cerebrovascular events(MACCE)and medicine side effect. Results No significantly difference was noted in baseline between the two groups. The level of CKMB and MA in the ticagrelor treated group[CK- MB(56.5±8.3)U/L,MA(45.9±6.4)mm[and clopidogrel treated group[CK- MB(74.3±9.6)U/L,MA(35.6±7.3)mm]were significant difference(CK- MB,P= 0.043;MA,P= 0.038). The MACCE of patients in ticagrelor treated group were significantly lower than patients in clopidogrel treated group during post- PCI 6 months follow- up(The ratio of angina in ticagrelor group was 1.7%,while in clopidogrel group was 6.7%,P= 0.042). Conclusion Ticagrelor is more effective in suppress the function of platelet, decrease MACCE in patients with STEMI undergoing PCI. Key words: Myocardial infarction; Percutaneous transluminal coronary angioplasty; Ticagrelor; Clopidogrel

The prognostic value of fragmented QRS complex of ECG in predicting re-occurrence of cardiac events after emergency percutaneous coronary intervention in patients with acute myocardial infarction

Objective To investigate the value of fragmented QRS complexes (fQRS) in predicting 1 year major adverse cardiac events (MACE) incidence after emergency percutaneous coronary intervention (PCI) for acute ST elevation myocardial infarction (STEMI).Methods Ninety-two acute myocardial infarction (AMI) patients treated with direct PCI were included and divided into fQRS group and non-fQRS group according to the presentations of 12-lead ECG recorded in 72 hours after PCI.The myocardial injury markers and MACE incidence were compared between the two groups during hospitalization.All patients were followed up for 1 year for the incidence of MACE.Results On the serial 12-lead ECG recorded for monitoring acute myocardial infarction patients during the in-hospital stay 72h after PCI,44/92 (47.8％) patients were included in non-fQRS group and 48/92 (52.2％) in fQRS group.Compared with non-fQRS group,the ischemic time before PCI was longer with increase in white blood cells count (WBC) after PCI in fQRS group (P =0.016 and P =0.026).Compared with non-fQRS group,the median of peak values of cTNI,CK-MB,and LVEF were respectively higher in fQRS group (P =0.035,0.003,0.048).The incidence of MACE during hospitalization was remarkably high but not significantly different between two groups (P =0.053).The peak values of cTNI,CK-MB were significantly higher in patients with fQRS presenting in both anterior and inferior wall than those in patients with fQRS presenting in anterior wall or inferior wall alone,while lower LVEF and higher MACE occurred in fQRS group without statistical difference from those in non-fQRS group.During a follow-up of mean one year,there were 19 MACE occurred in all patients.The incidence of 1 year MACE in fQRS group was significantly higher than that in non-fQRS group (31.3％ vs.9.1％,P =0.018).Survival analysis showed that event-free survival in fQRS group was significantly lower than that in non-fQRS group (P =0.004).COX model indicated that fQRS was an independent risk factor for re-occurreance of cardiac events in AMI patients after emergency PCI (HR:2.19,95％ CI:1.38-3.50,P =0.023).ROC curve was used for comparing the sensitivity and specialty between fQRS group and ST segment return from the elevated group in predicting MACE of which the area under curve (AUC) was 0.71 and 0.62,respectively without significant difference (Z =1.22,P =0.225).Conclusions fQRS can be used as an independent risk factor for predicting re-occurreance of cardiac events in AMI patients after emergency PCI. Key words: Acute myocardial infarction; Percutaneous coronary intervention; Fragmented QRS; Prognosis

FREQUENCY OF MECHANICAL COMPLICATIONS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Objective: To document the frequency of mechanical complications in patients with acute myocardial infarction. Methodology: The study was conducted from February 2009 to October 2011 in Cardiology department LRH. In this study, 5120 patients with acute ST elevation myocardial infarction (STEMI) were evaluated for mechanical complications. Acquired ventricular septal rupture (VSR), moderate to severe mitral regurgitation (MR), free left ventricular wall rupture, were considered as post-AMI mechanical complications. Diagnosis of VSR and MR were made on 2D and Color Doppler Echocardiography. Frequency, percentages and Mean±SD were used for categorical and numerical variables, respectively. Results: A total of 5120 patients were enrolled in the study,males were 54.4% , mean age was 61±9.7 years (45 to 85 years). Smokers were 21%, positive family history for coronary artery diseases was in 32%, hyperlipidemia in 18.5%, hypertensives were 14%, diabetics were 35% and 31.1% had history of coronary artery disease. Among these 68 (1.32%) patients had either acquired VSR and/or MR. VSR 44 (65.6%), MR 21(30.1%), while both VSR and MR were seen in 3(4.0%) patients. The number of patients who were timely thrombolysed with streptokinase was 30 (44.1%), half of these had either VSR or MR. More patients with mechanical complications had acute anterior MI, (52.9). The in-hospital mortality was 17.4%. Conclusion: Mechanical complications after acute myocardial infarction are a less common finding. Majority of the patients were in advanced age group. More patients with anterior MI had both VSR and MR. All those patients who died in hospital had acquired VSR.

Impact of high-density lipoprotein levels at hospital admission on the outcome of patients with acute ST-segment elevation myocardial infarction

To analyze the impact of high-density lipoprotein cholesterol (HDL-C) levels at hospital admission on the incidence of major adverse cardiovascular events (MACCE) in patients with acute ST segment elevation myocardial infarction (ASTEMI). 1067 patients with ASTEMI who were admitted to the 20 hospitals in Liaoning region and with lipid profile tested within the 24 hours of admission from May 2009 until May 2010, were enrolled. Data on basic demographic, clinical, status on admission and method of treatment were collected. Rate on various medical use and MACCE (cardiovascular death, non-fatal myocardial infarction, revascularization and stoke) were compared between the two groups through follow-up observation. Cox proportional hazard analysis was estimation. The median HDL-C level was 1.27 mmol/L, with 587 patients having HDL-C below and 489 patients HDL-C above the median level. The incidence rates of non-fatal myocardial infarction and MACCE at one-year follow-up period, was higher in low HDL-C group (4.8% vs. 0.9%, P<0.001; 23.7% vs. 18.1%, P=0.03, respectively). At one month follow-up, the incidence rate of non-fatal myocardial infarction was higher in low HDL-C group (1.4% vs. 0.0%, P=0.01). At six month follow-up, the incidence rates of non-fatal myocardial infarction and MACCE on one-year follow-up was higher in low HDL-C group (2.8% vs. 0.4%, P=0.003; 18.3% vs. 13.7%, P=0.04, respectively). from Cox proportional hazards analysis indicated that age (HR=1.02, 95%CI: 1.006-1.035, P=0.005), diabetes (HR=1.05, 95%CI: 1.053-2.171, P=0.03), HDL-C level (HR=0.56, 95%CI: 0.340-0.921, P=0.02) were significantly related to the incidence of MACCE. The incidence rates of one year and six month MACCE (mainly non-fatal myocardial infarction) and one month non-fatal myocardial infarction were significant higher in patients with low than high HDL-C levels at admission while kept on the ascending along with time. Age, diabetes, HDL-C level were independent risk factors related to the incidence of MACCE.

Application of clinical nursing pathway to treatment of acute ST——Elevation myocardial infarction

Objective To evaluate the effect of application of clinical nursing pathway to treatment of acute ST--Elevation myocardial infarction (STEMI).Methods A total of 60 STEMI patients were divided into two groups.Experimental group were received treatment and care according to the designed STEMI clinical pathway table.Control group were treated and nursed with the conventional emergency mode.Results The time of emergency PCI of the experimental group was less than teat of control group(P<0.05)treatment success rate was higher than the control group.Total hospital costs,medicine costs and hospital days were significantly lower in experiment group,while health education and satisfaction were significantly higher(P <0.05).Conclusions The application of clinical pathway in the STEMI could win precious time of their treatment for patients,reduce medical costs and improve quality of care.It is in line with the current demand of China's health system and therefore is worth to promoting. Key words: Acute ST--Elevation Myocardial infarction; Clinical nursing pathway; Percutaneous coronary intervention

Which is the best streptokinase regimen in ST acute myocardial infarction? A prospective study

Which is the best streptokinase regimen in ST acute myocardial infarction? A prospective study

Safety and efficacy of an accelerated streptokinase regimen in combination with enoxaparin in the prehospital management of the ST acute myocardial infarction (ASENOX-2) study

Safety and efficacy of an accelerated streptokinase regimen in combination with enoxaparin in the prehospital management of the ST acute myocardial infarction (ASENOX-2) study

Cardiovascular responses to early exercise in inferior wall ST acute myocardial infarction

The heart rate and blood pressure responses to standardized exercise tests were studied in a group of patients with electrocardiographic evidence of inferior wall acute myocardial infarction (AMI). The tests were done on a bicycle ergometer at 8 to 10 days and 10 to 12 weeks after AMI. At 8 to 10 days after AMI, those with ST AMI (n = 12) had a significantly reduced heart rate response to exercise compared with patients with Q-wave AMI (n = 25). This difference was not evident at 10 to 12 weeks. The systolic blood pressure response in patients with ST AMI was lower than that of Q-wave AMI patients during the first exercise test, although the difference did not attain statistical significance but was significantly lower than the responses of both groups at the second test. The patients with ST AMI had smaller amounts of myocardial damage than those with Q-wave AMI as indicated by plasma creatine kinase values (p < 0.01). These differences in the heart rate responses appeared to result from the preferential activation of nonmyelinated afferent fibers in the subepicardial region of the inferior wall of the myocardium.