Anterior ST-elevation Myocardial Infarction Research Articles

Interpreting the ECG in patients with chest pain and right bundle branch block: A case report.

A patient with right bundle branch block (RBBB) presented with chest pain. An ECG showed ST-elevation in leads V1, V2, and aVR, with widespread ST-depression in leads II, aVF, I, aVL, and V4-6. The initial ECG interpretation missed ST-elevation myocardial infarction (STEMI), as ST-elevation thresholds were not reached. Non-urgent angiography showed severe left anterior descending artery stenosis requiring percutaneous coronary intervention. The course was complicated by cardiac arrest necessitating resuscitation and dual chamber pacemaker placement with left bundle branch pacing. This case report outlines the deficiencies of the current voltage criteria for identification of anterior STEMI in patients with RBBB.

The Role of Index of Microcirculatory Resistance in Left Anterior Descending Artery ST Segment Elevation Myocardial Infarction Patients With Thrombolysis in Myocardial Infarction Myocardial Perfusion Grade 3 After Primary Percutaneous Coronary Intervention

The Role of Index of Microcirculatory Resistance in Left Anterior Descending Artery ST Segment Elevation Myocardial Infarction Patients With Thrombolysis in Myocardial Infarction Myocardial Perfusion Grade 3 After Primary Percutaneous Coronary Intervention

Case Report: Smoking as the risk factor of persistent STEMI after primary percutaneous coronary intervention: how it could be happen?

Background Acute coronary syndrome (ACS) is a common disease. Smoking may increase the risk of ACS. The most advantageous therapy is percutaneous coronary intervention. This therapy may fail which is no-reflow phenomenon as the result. Total occlusion may increase the risk of no-reflow phenomenon which it could be worse with smoking as the habits. ST-elevation myocardial infarction (STEMI) may show in electrocardiogram (ECG). Case description A 37-year-old male came to the hospital with chest pain as the main complaint. ECG examination showed that there was wide anterior STEMI. Coronary angiography was then done and confirmed that there was total occlusion in left anterior descending artery. After two days hospitalization, the patient developed to cardiogenic shock and lead to acute decompensated heart failure. An ECG showed there was STEMI anterior after primary PCI. Discussion Many chemicals agent contain in cigarette smoking and it may induce the lipid oxidation which leads to plaque deposits. Plaque that deposits in coronary artery may rupture and make thrombus occlusion. This occlusion may partial or total, when there is total occlusion, STEMI was the result. Then, releasing the occlusion is needed for this situation ant PCI may be chosen as the therapy. Patient with wide ischemia may result the no-reflow phenomenon which may lead to heart failure and shock cardiogenic as the complication. Conclusion Smoking may induce ACS which leads to STEMI and may increase the failure of PCI therapy. No-reflow phenomenon is the evidence of miscarriage in therapy which it may increase because of smoking.

Lessons in clinical reasoning- pitfalls, myths, and pearls: a case of crushing, substernal chest pain.

Diagnostic error is not uncommon and diagnostic accuracy can be improved with the use of problem representation, pre-test probability, and Bayesian analysis for improved clinical reasoning. A 48-year-old female presented as a transfer from another Emergency Department (ED) to our ED with crushing, substernal pain associated with dyspnea, diaphoresis, nausea, and a tingling sensation down both arms with radiation to the back and neck. Troponins were elevated along with an abnormal electrocardiogram. A negative myocardial perfusion scan led to the patient's discharge. The patient presented to the ED 10days later with an anterior ST-elevation myocardial infarction. An overemphasis on a single testing modality led to diagnostic error and a severe event. The use of pre-test probabilities guided by history-taking can lead to improved interpretation of test results, ultimately improving diagnostic accuracy and preventing serious medical errors.

Usefulness of contrast echocardiography for detection of left ventricular thrombus in a real-world population with acute anterior myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction The treatment of ST-elevation myocardial infarction (STEMI) has considerably changed in recent years, with early, mainly transcatheter reperfusion therapy improving survival. However, left ventricular thrombus (LVT) is still reported as a relatively common complication especially in anterior STEMI. Two-dimensional transthoracic echocardiography (TTE) is the most commonly used diagnostic modality in this setting due to its wide availability and low cost but can lead to misdiagnoses. The use of ultrasound contrast agents has dramatically improved the visualization of cardiac chambers and thus detection of LVT. Purpose The purpose of this study was to assess the value of contrast echocardiography (CE) for the detection of apical LVT in a real-world population of patients with acute anterior myocardial infarction (MI) in the modern era. Methods The population of this prospective study consisted of consecutive patients presenting within a year with acute anterior MI in a tertiary hospital with capability of primary percutaneous coronary intervention (PCI). Patients with confirmed COVID-19 infection and/or current use of anticoagulant medication were excluded from the study. All patients underwent TTE without and with contrast within 7 days post-MI by an experienced cardiologist. CE was considered the reference standard. Results A total of 102 patients (mean age 61±13 years, 19% female) with anterior STEMI were prospectively recruited in our study. Ninety-eight patients underwent primary PCI, 3 patients underwent rescue PCI after unsuccessful thrombolysis, 1 patient underwent surgical revascularization. Two patients did not receive contrast agent (1 due to known hypersensitivity to contrast agent and 1 due to cardiogenic shock). Mean ejection fraction (EF) was 46% ± 10% in total population and was significantly lower in patients with LVT (42% ± 7% vs 47% ± 10%, p = 0.025). The incidence of confirmed LVT by CE was 28% (28/100) within 7 days post-MI. In total, 8 out of 28 LVT cases (28.5%) would have been missed using TTE without contrast within 7 days post-MI (sensitivity 71%, specificity 100%, positive predictive value 100% and negative predictive value 90%). Example of missed LVT on TTE without and with contrast (left and right panel respectively) is shown in Figure 1. Conclusions LVT is not uncommon after anterior STEMI in the modern era of primary PCI. LVT would have been missed in a significant proportion of patients with anterior STEMI if CE was not used, depriving these patients from the option of early anticoagulation treatment.

ST-elevation myocardial infarction complicated by ventricular tachycardia revealing coronary artery ectasia: a case report

BackgroundCoronary artery ectasia is a rare angiographic finding and results from a disease process that compromises the integrity of the vessel wall. Its prevalence ranges between 0.3% and 5% of patients undergoing coronary angiography (Swaye et al. in Circulation 67:134–138, 1983). Coronary artery ectasia in patients with ST-elevation myocardial infarction is associated with an increased risk of cardiovascular events and death after percutaneous coronary intervention.Case presentationWe report the case of a 50-year-old male Caucasian patient, admitted for ventricular tachycardia at 200 beats per minute hemodynamically not tolerated that was reduced by external electric shock. Electrocardiogram after cardioversion showed a sinus rhythm with anterior ST-elevation myocardial infarction. Thrombolytic therapy was chosen after exposure to dual antiplatelet therapy and heparin since the expected time to percutaneous coronary intervention was greater than 120 minutes from first medical contact and the patient presented within 12 hours of onset of ischemic symptoms. The electrocardiogram after thrombolysis showed the resolution of the ST segment. The echocardiogram showed a dilated left ventricle with severe dysfunction with left ventricle ejection fraction at 30%. Coronary angiography revealed non-obstructive giant ecstatic coronaries without any thrombus. A check-up to look for possible etiologies for coronary artery ectasia was carried out and returned normal. Since no etiology for coronary artery ectasia was found at the limit of available exams in our center, the patient was discharged with antiplatelet therapy (aspirin 100 mg once a day) and heart failure treatment with an indication for an implantable cardiac defibrillator.ConclusionsCoronary artery ectasia in the context of acute myocardial infarction is a rare condition that may have dangerous complications, especially when an optimal treatment for ecstatic culprit vessels is still controversial.

Persistent mortality and heart failure burden of anterior ST-segment elevation myocardial infarction following primary percutaneous coronary intervention: real-world evidence from the US Medicare Data Set

ObjectivesWe sought to compare the temporal trends in the incidence of death and rehospitalisation for congestive heart failure (CHF) following anterior ST-elevation myocardial infarction (STEMI) in a Medicare cohort of...

Coexisting nephrotic syndromes influences in st elevation myocardial infarction patient and chronic limb-threatening ischemia patient: is there any correlation?

Background: ST elevation myocardial infarction (STEMI) and chronic limb-threatening ischemia (CLTI) were cardiovascular emergencies and require urgent reperfusion treatment. Both diseases shared same traditional cardiovascular risk factors. Nephrotic syndrome (NS) patients were known for risk of thromboembolic complications that may present as STEMI or CLTI, result of hypercoagulable state stemming leading to thrombus formation. Case illustration: Three cases were described in a case series. The first case presented with anterior extensive STEMI, coroangiography revealed total occlusion at proximal left anterior descending artery with high burden thrombus, treated with defered stenting and medical therapy. The second case presented with CLTI, imaging modality showed occlusion with thrombus in infra-renal abdominal aorta until bilateral superficial femoral artery (SFA), the patient refused any interventional treatment, so he was treated with medical therapy only. The third case presented with CLTI on left leg and chronic limb ischemia on right leg, imaging modality showed occlusion at left external iliac artery and 1/3 distal of right SFA with prominent plaque calcification, treated with percutaneous transluminal angioplasty, and medical therapy. All patients achieved significant improvement in the disease. Conclusion: NS is a risk factor for STEMI and CLTI. Even corticosteroids for NS treatment also a risk factor for thromboembolic complications. Controlling the disease severity with precaution of the therapy side effect should be achieved. If thromboembolic complications related to NS happen, the management mainly follows the available guidelines.

Effectiveness of early angiography and intervention for treating anterior ST-elevation myocardial infarction involving diagonal branches

Background: ST-elevation myocardial infarction (STEMI) is life-threatening condition requiring prompt medical attention. The diagonal branches are a group of blood vessels that supply blood to the front of the heart, and their involvement in anterior STEMI can result in worse outcomes. Early diagnosis and intervention are essential for enhancing patient outcomes. Objectives: This study's objective is to assess the efficacy of early angiography and intervention in the treatment of anterior STEMI involving diagonal branches. Methods: We conducted cross-sectional investigation of patients admitted to Medical Training Institute, Lady Reading Hospital, Peshawar, Pakistan during 2022-23, with anterior STEMI involving diagonal branches, including 250 patients whom underwent early angiography and intervention within 12 hours of symptom onset. Medical records were mined for clinical data, including demographics, medical history, electrocardiogram (ECG) findings, hematological laboratory results, and treatment modalities. The primary outcome measure was all-cause mortality at 30 days following hospitalization. Results: Mean age of STEMI patients was 61.91+8.71 years, and 68.8% were males. Median time between onset of symptoms and hospitalization was 3.50+0.78 hours. The 30-day mortality rate was 10.8% overall (27/250). Our results indicated that early intervention improved mortality outcomes, whereas late intervention increased the number of cases requiring revascularization.

How an Aggressive Treatment of No-reflow Phenomenon in Primary Percutaneous Coronary Intervention with High Thrombus Burden can Achieve a Grade III TIMI-flow: A Case Report

Abstract Introduction The management of the no-reflow phenomenon is still being debated by experts as there is no specific algorithm, limited recommended drug choices, and insufficient data regarding the combination of drugs in currently available guidelines. Thus, in this case report, we would like to propose a new combination of drugs as an alternative to the recommended drugs of choice in the treatment of no-reflow phenomenon. Case Presentation A 41-year-old man arrived at the emergency department complaining of chest pain 30 minutes prior to arrival. However, the patient was later diagnosed with extensive anterior ST-elevation myocardial infarction, KILLIP classification I, which was caused by the entire blockage of the proximal left anterior descending coronary artery. Angiography was conducted after stent placement during the main percutaneous coronary intervention and revealed grade I thrombolysis in myocardial infarction (TIMI)-flow with no coronary artery blockage. We then used an intracoronary approach to give nitroglycerin, heparin, and eptifibatide. The findings of posttreatment angiography revealed an improvement in coronary blood flow with a grade II TIMI flow. Furthermore, intravenous injection of eptifibatide and morphine effectively restored perfusion to a grade III TIMI flow. Conclusion Aggressive and precise treatment with a drug of choice is required to counteract the no-reflow phenomenon. Presently, only a limited range of first-line medications are available to treat this condition. Not only that, but several of the prescribed medications are not easily accessible, especially in developing countries. Therefore, we offer a novel combination medicaments consisting of nitroglycerin, heparin, and glycoprotein IIb/IIIa inhibitor as an alternative treatment of the no-reflow phenomenon.

Temporal electrocardiographic changes in anterior ST elevation myocardial infarction versus the Takotsubo syndrome.

Electrocardiography (ECG) on admission is similar in ST elevation myocardial infarction (STEMI) and Takotsubo syndrome (TTS). ECG on admission has been extensively investigated and compared between STEMI and TTS, however, only a few studies have compared temporal ECG. Our aim was to compare ECG in anterior STEMI versus female TTS from admission to day 30. Adult patients with anterior STEMI or TTS treated at Sahlgrenska University Hospital (Gothenburg, Sweden) from December 2019 to June 2022 were prospectively enrolled. Baseline characteristics, clinical variables and ECGs from admission to day 30 were analyzed. Using a mixed effects model, we compared temporal ECG between female patients with anterior STEMI or TTS, as well as between female and male patients with anterior STEMI. A total of 101 anterior STEMI patients (31 female, 70 male) and 34 TTS patients (29 female, 5 male) were included. The temporal pattern of T wave inversion was similar between female anterior STEMI and female TTS, as well as between female and male anterior STEMI. ST elevation was more common, whereas QT prolongation was less common, in anterior STEMI compared with TTS. Q wave pathology was more similar between female anterior STEMI and female TTS than between female and male anterior STEMI. The pattern of T wave inversion and Q wave pathology from admission to day 30 was similar in female patients with anterior STEMI and female patients with TTS. Temporal ECG in female patients with TTS may be interpreted as following a "transient ischemic" pattern.

IN-HOSPITAL OUTCOMES OF PATIENTS PRESENTING WITH ANTERIOR WALL MYOCARDIAL INFARCTION WITH RIGHT BUNDLE BRANCH BLOCK

BACKGROUND: Acute myocardial infarction is a common heart disease associated with signicant morbidity and mortality. Data on the Clinical, Electrocardiographic and Angiographic prole of acute anterior wall ST-elevation myocardial infarction with Right Bundle Branch Block with q waves in leads v1, v2 are scarce. The aim of this study is to compare the mortality and in hospital outcomes of patients with anterior wall myocardial infarction with RBBB and without RBBB. The study design is a METHODS: retrospective study among the patients admitted with acute anterior wall STEMI with qRBBB and non qRBBB pattern on ECG during the time period March to August 2022. All relevant clinical and treatment data were collected from the medical records department, Government Royapettah Hospital. ECGs taken during the hospitalization of the patient were subjected to detailed analysis and their outcomes were recorded. RESULTS: Among the 50 patients with anterior wall myocardial infarction 11 patients presented with qRBBB pattern. Out of these 11patients, 7 patients had higher Killip score at presentation and 4 of them succumbed to death (57%).The in-hospital mortality rate was higher among those who had anterior wall myocardial infarction with qRBBB pattern when compared to non qRBBB pattern. There was a higher incidence of cardiogenic shock (54%) among patients with qRBBB pattern. Acute anterior wall MI wit CONCLUSION: h qRBBB myocardial infarction is a severe form of acute coronary syndrome with higher in-hospital mortality and morbidity necessitating early recognition and prompt institution of reperfusion therapy. Cardiogenic shock, ventricular tachycardia, higher Killip and TIMI scores at presentation are signicant predictors of inhospital mortality

A Rare Case of Acute Stanford Type a Aortic Dissection Presenting with Anterior St-Elevation Myocardial Infarction

Abstract Introduction Aortic dissections occur as a result of a tear in the intimal layer, continued longitudinal splitting within the intima and media, and formation of false lumen. This could lead to sudden death or severe aortic regurgitation and cardiogenic shock. The presented case here describes a patient with acute anterior ST-elevation myocardial infarction due to acute Stanford type A ascending aortic dissection. Case presentation A 55-year-old male presented with severe chest pain, radiating into the back, jaw, and left arm, and signs of cardiogenic shock. Electrocardiography showed acute anterior ST-elevation myocardial infarction and echocardiography confirmed that there was a reduced left ventricle ejection fraction (38% calculated using the Simpson method), severe aortic regurgitation, and wall motion abnormalities. Based on these findings, we made a diagnosis of acute myocardial infarction. In accordance with the current guidelines, we opted for an interventional therapeutic approach. Angiography showed left main trunk dissection extending to the left anterior descending coronary artery caused by ascending aorta dissection. This finding altered the diagnosis and treatment plan and the patient was immediately sent to the operating room for emergency surgery. Conclusions Aortic dissection should be suspected in patients presenting with acute anterior ST-elevation myocardial infarction, severe aortic regurgitation, and cardiogenic shock. Involvement of the left main trunk and left anterior descending artery occurs much more rarely than that of the right coronary artery, which causes inferior myocardial infarction.

Impact of dapagliflozin on cardiac function following anterior myocardial infarction in non-diabetic patients – DACAMI (a randomized controlled clinical trial)

BackgroundThe role of Sodium-glucose co-transporter 2 inhibitors (SGLT2i) in heart failure is established. Early data also suggests their favorable role in patients with acute coronary syndromes, but more evidence is still needed. MethodsIn this dual center, double-blinded randomized controlled trial, non-diabetic patients (N = 100) who presented with anterior ST- elevation myocardial infarction (STEMI) & had undergone successful primary percutaneous coronary intervention, but their left ventricular ejection fraction was below 50%, were randomized to dapagliflozin 10 mg or a placebo once daily. The primary endpoint was a change in cardiac function assessed by N-terminal pro-Brain Natriuretic Peptide – NT-proBNP measured at baseline & 12 weeks post the cardiac event &/or echocardiographic parameters (left ventricular ejection fraction, left ventricular diastolic dimension & left ventricular mass index) assessed at baseline, 4-weeks & 12-weeks post the cardiac event. ResultsFrom October 2021 to April 2022, 100 patients were randomized. The mean drop of NT- proBNP in the study group was more significant compared to the control group by 10.17% (95% CI: −3.28–19.67, p-value 0.034). In addition, the decrease in the left ventricular mass index (LV mass index) was also significant in the study group compared to the control group by 11.46% (95% CI: −19.37 to −3.56, p-value 0.029). ConclusionsDapagliflozin seems to have a role in preventing left ventricular dysfunction & maintaining cardiac function following anterior ST-elevation myocardial infarction. More Large-scale trials need to be done to confirm these findings further.This trial is locally registered at the National Heart Institute, Cairo – Egypt, and Faculty of Medicine, Ain Shams University, with reference numbers CTN1012021 & MS-07/2022, respectively. It is also registered retrospectively at the US National Institutes of Health (ClinicalTrial.gov) with identifier number: NCT05424315 – June 16th,2022.

Clinical trials of sonothrombolysis for Acute Coronary Syndromes

Diagnostic high mechanical index (MI) ultrasound in conjunction with microbubble infusion in patients with acute ST-elevation myocardial infarction (STEMI) may be a method of achieving early recanalization, (sonothrombolysis). To evaluate the safety, efficacy and prognostic impact of sonothrombolysis in patients with acute coronary syndromes (ACS). We will randomize 540 patients with anterior STEMI in the “High Ultrasound Mechanical Index and MicrobuBBLEs to reduce acute myocardial infarction burden” (HUBBLE-I). Sonothrombolysis (50 min) was performed using multiple intermittent high MI impulses when microbubbles were imaged within the risk area (Therapy Group) or only 3 projections of low MI imaging alone plus microbubbles (Control Group) in 5 patient subgroups: G1-STEMI pre-PCI; G2-STEMI after lytic therapy; G3-Unstable angina and non-STEMI; G4-STEMI post-PCI; G5-STEMI pre-PCI treated in ambulances. Recanalization, ejection fraction, troponin and MB-CK levels were acquired at baseline, pre-PCI and follow-up. Global longitudinal strain was serially measured. The number of patients randomized to control versus therapy was 47(23/24), as follows: G1- 12 (5/7); G2- 13 (9/4); G3- 14 (8/6); G4- 8 (4/4) and G5- 0(0/0). This multicenter, Phase III randomized trial in patients with ACS treated by sonothrombolysis will assess safety, efficacy, and prognostic impact of this therapy.

Association of Left Ventricular Systolic Function with Diagonal Branch Flow in Patients with First Anterior ST-Elevation Myocardial Infarction Treated with Primary Angioplasty

Background: There are few studies about the impact of diagonal branch blood flow on echocardiographic findings in patients with first acute anterior myocardial infarction undergoing primary angioplasty. Objectives: We aimed to compare left ventricular systolic function measures in patients with first acute anterior ST-segment elevation myocardial infarction (STEMI) treated with primary angioplasty based on diagonal branch blood flow after the procedure. Methods: This study was a single-center study that enrolled patients with their first acute anterior STEMI treated with primary angioplasty in our center between October 2020 and March 2021. Patients were divided into two groups: The patients with final thrombolysis in myocardial infarction (TIMI) flow III in diagonal (sufficient diagonal flow) and patients with final TIMI flow less than III in diagonal (insufficient diagonal flow) after the procedure. The left ventricular Wall-Motion Score Index (WMSI) and left ventricular ejection fraction (LVEF) were compared between the two groups. Results: A total of 107 patients with first anterior STEMI treated with primary PCI were enrolled in the present study, of which 13 patients (12.1%) had insufficient diagonal flow after primary coronary angioplasty. The LVEF was lower in patients with insufficient diagonal flow (32.92 ± 7.29% vs. 39 ± 8.68%, P = 0.018). Also, this group had higher LV WMSI (1.68 ± 0.28 vs. 1.49 ± 0.26, P = 0.029). Conclusions: The present study showed that in patients with first acute anterior STEMI undergoing primary angioplasty, insufficient diagonal branch flow after the procedure was associated with worse left ventricular systolic function and higher LV WMSI.

Microvascular obstruction identifies a subgroup of patients who benefit from stem cell therapy following ST-elevation myocardial infarction

Microvascular obstruction (MVO) is associated with greater infarct size, adverse left-ventricular (LV) remodeling and reduced ejection fraction following ST-elevation myocardial infarction (STEMI). We hypothesized that patients with MVO may constitute a subgroup of patients that would benefit from intracoronary stem cell delivery with bone marrow mononuclear cells (BMCs) given previous findings that BMCs tended to improve LV function only in patients with significant LV dysfunction. We analyzed the cardiac MRIs of 356 patients (303 M, 53 F) with anterior STEMIs who received autologous BMCs or placebo / control as part of 4 randomized clinical trials that included the Cardiovascular Cell Therapy Research Network (CCTRN) TIME trial and its pilot, the multicenter French BONAMI trial and SWISS-AMI trials. A total of 327 patients had paired imaging data at 1 year. All patients received 100 to 150 million intracoronary autologous BMCs or placebo / control 3 to 7 days following primary PCI and stenting. LV function, volumes, infarct size and MVO were assessed prior to infusion of BMCs and 1 year later. Patients with MVO (n = 210) had reduced LVEF and much greater infarct size and LV volumes compared to patients without MVO (n=146) (P < .01). At 12 months, patients with MVO who received BMCs had significantly greater recovery of LVEF compared to those patients with MVO who received placebo (absolute difference=2.7%; P < .05). Similarly, left-ventricular end-diastolic (LVEDVI) and end-systolic volume indices (LVESVI) demonstrated significantly less adverse remodeling in patients with MVO who received BMCs compared to placebo. In contrast, no improvement in LVEF or LV volumes was observed in those patients without MVO who received BMCs compared to placebo. The presence of MVO on cardiac MRI following STEMI identifies a subgroup of patients who benefit from intracoronary stem cell therapy.

CRT-100.29 The Role of Index of Microcirculatory Resistance in Left Anterior Descending Artery ST Segment Elevation Myocardial Infarction Patients With Thrombolysis in Myocardial Infarction Myocardial Perfusion Grade 3 After Primary Percutaneous Coronary Intervention

CRT-100.29 The Role of Index of Microcirculatory Resistance in Left Anterior Descending Artery ST Segment Elevation Myocardial Infarction Patients With Thrombolysis in Myocardial Infarction Myocardial Perfusion Grade 3 After Primary Percutaneous Coronary Intervention

The impact of the complete atrioventricular block on in-hospital and long-term mortality in patients treated with primary percutaneous coronary intervention

Background/Aim. The prognostic impact of complete atrioventricular (AV) block on the long-term prognosis of patients with ST-elevation myocardial infarction (STEMI) has not been fully determined. The aim of the study was to analyze the incidence and prognostic impact of complete AV block on in-hospital mortality (IHM) and 6-year mortality in STEMI patients treated with primary percutaneous coronary intervention. Methods. The study included 3,044 consecutive STEMI patients. Results. Complete AV block was registered only on admission in 144 (4.73%) patients; 125 (86.8%) patients with complete AV block had inferior infarction. A temporary pacemaker was implanted in 72 (50%) patients with complete AV block. No patient under-went permanent pacemaker implantation. IHM was significantly higher in patients with complete AV block than in patients without complete A V b lock: 1 7.9% v s. 3 .6%, respectively, p &lt; 0.001. In patients with heart block and inferior infarction, IHM was 13%, whereas IHM was 53% in patients with heart block and anterior infarction. When we analyzed patients discharged alive from the hospital, we also found a significantly higher long-term (6-year) mortality rate in those with complete AV block vs. patients without AV block: 7.8% vs. 3.4%, respectively, p &lt; 0.001. Complete AV block was an independent predictor for IHM and 6-year mortality: IHM [odds ratio (OR) 2.94 95%, confidence interval (CI) 1.23?5.22; 6-year mortality hazard ratio (HR) 1.61, 95%, CI 1.10?2.37]. When subanalysis was performed in patients with inferior STEMI, complete AV block was an independent predictor of IHM and 6 -year mortality, while in patients with anterior STEMI, complete AV block was an independent predictor of IHM. Conclusion. In analyzed STEMI patients, complete AV block was transitory and was registered only on hospital admission. Although transitory, complete AV block remained a strong independent predictor of IHM and long-term mortality.

Delayed Percutaneous Coronary Intervention Versus Conventional Medical Treatment for Management of Late Comers with Anterior ST Segment Elevation Myocardial Infarction

Delayed Percutaneous Coronary Intervention Versus Conventional Medical Treatment for Management of Late Comers with Anterior ST Segment Elevation Myocardial Infarction