Diagnosis Of Acute ST-elevation Myocardial Infarction Research Articles

Invasive versus Conservative Treatment Approach among Older Adult Patients Admitted with Acute ST-Segment Elevation Myocardial Infarction.

Primary percutaneous coronary intervention (PCI) is the preferred treatment strategy for patients with ST-elevation myocardial infarction (STEMI); however, its efficacy remains unclear in very older adult patients with STEMI. This retrospective single-center observational study included 530 patients aged >75 years admitted to Tel Aviv Sourasky Medical Center with a diagnosis of acute STEMI. Primary PCI was performed for patients with symptoms ≤12 hours in duration, while the other patients were conservatively treated. We evaluated 30-day mortality and complications occurring during hospitalization based on data from patient records. Among the study patients, only 28/530 (5%) were conservatively treated. In-hospital complications, including the use of inotropes or intra-aortic balloon counterpulsation and the need for mechanical ventilation, did not differ significantly between the groups. The only parameter that showed a trend toward significance was the incidence of heart failure during hospitalization (p=0.042). The risk for 30-day mortality was substantially higher in the conservative treatment group than in the invasive treatment group (27% vs. 10%; p = 0.02). Our data suggested that despite concerns regarding the safety of the primary PCI strategy in the older adult STEMI population, this treatment strategy was associated with a survival benefit.

A Study of Clinical Profile and Complications In Patients with ST-Elevation Myocardial Infarction Attending In College of Medical Sciences Teaching Hospital, Bharatpur (Chitwan), Nepal.

Background and Aims: ST-Elevation Myocardial Infarction (STEMI) is a leading cause of morbidity and mortality. This study aims to summarize the clinical profile and complications of patients with STEMI in a teaching hospital.
 Methods: This was a prospective hospital based descriptive and observational study conducted at College of Medical Sciences Teaching Hospital (CoMSTH), Bharatpur from January 2017 to July 2018 in 110 patients with a diagnosis of acute STEMI.
 Results: Out of 110 patients the mean age of presentation was 59.31 years and 64.5% were male. Typical chest pain (90%) was the most common presenting symptom and 45.5% patients presented within six hours of chest pain. Most common traditional risk factors were hypertension and smoking which were present in 44 (40%) cases, followed by diabetes in 33 (30%), dyslipidemia in 22 (20%). Majority of patients (49.1%) were in killips class I, and only 9 (8.2%) patients were in cardiogenic shock (killips class IV). Inferior wall was the most common in 30% patients followed by anteroseptal wall MI (23.6%), anterior wall MI (11.8%) and combined (anterior and inferior) in 10%. Revascularization with primary Percutaneous Coronary Intervention (PCI) was done in 46 (41.8%) patients, thrombolysis was done in 41 (37.3%) patients. Arrhythmias (39.1%) followed by heart failure (24.5%) were the common complications. The overall in-hospital mortality was 16 (14.5%).
 Conclusions: Patients with acute STEMI at College of Medical Sciences Teaching Hospital (CoMSTH) were predominantly male with hypertension and smoking as the commonest risk factors. Arrhythmias were the most common complications and in-hospital mortality rate was 14.5%.

Retrospective analysis of the status and trend of diagnosis and treatment of acute ST-segment elevation myocardial infarction in county hospitals of Liaoning province in 2013-2015

Objective To investigate the changes of diagnosis and treatment of acute ST-segment elevation myocardial infarction in northern Liaoning, and to provide a reference for further improvement of diagnosis and treatment of acute ST-elevation myocardial infarction in northern Liaoning. Methods A retrospective study was performed on 453 cases of patients with acute ST-elevation myocardial infarction in Liaoning country level hospital from January 1, 2013 to December 31, 2015.To investigate and analyze the patients′clinical features, diagnosis, treatment status and outcome. Results From 2013 to 2015, there were no significant differences in demographic characteristics, risk factors, past medical history, mode of treatment and MACE events in the patients with acute ST-segment elevation myocardial infarction at the county level hospitals in northern Liaoning province(P>0.05). Application of percutaneous coronary intervention(PCI)in 6.2% to 21.6%(P>0.05). The ratios of patiens who accepted fibrinolytic therapy in three years have no difference(P>0.05). There was no statistically significant difference in the application of aspirin and β- blockers for 3 years(P>0.05). Administration of clopidogrel elevated from 36.3% to 64.2%, P<0.05.Administration ACEI/ARB elevated from 45.2% to 71.0%, and stains from 65.8% to 81.8%. Conclusion The acute ST-segment elevation myocardial infarction in 3 years in northern Liaoning Province has been improved in the application of reperfusion and drug specification.However, there were still obvious gaps for diagnosis and treatment from the guideline requirement; the patient outcomes have not been improved. Key words: The north of Liaoning province; ST-segment elevation acute myocardial infarction; Status of diagnosis and treatment

Acute kidney injury based on the KDIGO criteria among ST elevation myocardial infarction patients treated by primary percutaneous intervention.

Acute kidney injury (AKI) following acute ST elevation myocardial infarction (STEMI) is associated with adverse outcomes. The recently proposed KDIGO criteria suggested modifications to the consensus classification system for AKI, namely lowering the threshold of increase in absolute serum creatinine and extending the time frame for AKI detection to 7days. We evaluated the incidence, risk factors, and long-term mortality associated with AKI as classified by the KDIGO definition in a large single center cohort of consecutive STEMI patients. We retrospectively studied 2122 consecutive STEMI patients undergoing primary percutaneous coronary intervention (PCI). Recruited patients were admitted between January 2008 and May 2016 to the cardiac intensive care unit with the diagnosis of acute STEMI. We compared the utilization of the KDIGO and consensus criteria for the diagnosis of AKI and its relation to long term mortality. The KDIGO criteria allowed the identification of more patients as having AKI (10.6 vs. 5.6%, p < 0.001) compared to the consensus criteria. Even mild elevation of serum creatinine (≥ 0.3mg/dL) was associated with a marked increase in all-cause mortality (HR 4.7, 95% CI 3.1-6.43, p < 0.001). Patients with AKI whose renal function resolved prior to hospital discharge still had significantly higher mortality compared to patients with no AKI (23 vs. 8%, HR 3.1, 95% CI 2.09-4.90, p < 0.001). KDIGO criteria is more sensitive than the consensus criteria in defining AKI in STEMI patients and identifying populations at risk for long term adverse outcomes.

Acute ST-Elevation Myocardial Infarction in Young in Shahid Gangalal National Heart Centre, Kathmandu, Nepal

Background and Aims: Acute ST elevation myocardial infarction (STEMI) is often present in old populations. STEMI in young has significantly increased in recent years. We aim to study the conventional risk factors, clinical presentation, management and outcome of Acute STEMI in young patients.Methods: Medical records of all the young patients (aged less than 45 years), who were admitted in our hospital with the diagnosis of Acute STEMI and treated in between 1st July 2015 to 30th June 2016, were retrospectively reviewed. Demographics, conventional risk factors, clinical presentation, management and outcome were recorded.Results: There were total 1211 patients admitted for Acute STEMI, among them, 132(10.9%) were young patients, age ranged from 24 to 45 years with mean age 39.1±4.8 years, with 110 males. Anterior wall MI 50(37.8%) was the most common MI. Symptom onset to arrival to hospital ranged from 1 hour to 144 hours with mean of 19.4±2.4hours. Primary PCI was the mode of reperfusion in 59(44.6%) patients; thrombolysis was done in 19(14.3%) patients. The most common conventional risk factor was tobacco consumption; present in 91(68.9%) patients. Tobacco consumption was the only conventional risk factors in 27(20.4%) patients. There were four (4%) in-hospital mortality. Among the discharged patients all patients received Aspirin, Clopidogrel and Statin. Betablocker and Angiotensin converting enzyme inhibitor/Angiotensin receptor blocker were prescribed in 99(75%) and 96 (72.7%) patients respectively. Mean left ventricular ejection fraction was 45.5±8.6%, with 99(77.3%) having Ejection Fraction ≥40%.Conclusions: Acute STEMI in young was common in male. Tobacco consumption was significant riskfactor. Acute STEMI in young has good prognosis.Journal of Advances in Internal Medicine 2017;06(02):27-31.

Gender Difference in Presentation, Management and Inhospital Mortality in St Elevation Myocardial Infarction in a Tertiary Cardiac Center

Background: Studies have shown that women are less likely to receive reperfusion therapy and have higher inhospital death in ST Elevation myocardial infarction(STEMI) as compared to men. This study aims to examine presentation, acute therapy, and inhopital mortality in women admitted with diagnosis of acute STEMI in a tertiary care cardiac center.Methods: Patients admitted with diagnosis of acute STEMI from 1st June 2013 to 31st May 2015 were included in the study. Gender difference in baseline characterstics, comorbidities, prehospital delay, type of treatment received and inhospital death were measured. Variables that might have impact on inhospital deaths were analyzed on multivariate regression analysis to find out other variables adjusted effect of gender on inhospital deaths.Results : Majority of the patients were men (Men 69% vs women 31%). Women were older, were more likely to be diabetics and smoker. Prehospital delay was more in women ( women 22 hours vs men 12 hours, p value-0.02).About 46% of both men and women received reperfusion therapy. There was more inhospital mortality in women (women 13.5% vs men 6.5%, p value – 0.02). Women had more inhospital mortality even after adjustment with other covariables (OR = 3.110, 95% CI = 1.411-6.902, p value-0.005).Conclusion : Women were more likely to be elderly, diabetics, smoker and presented later than men after symptoms onset. Women received reperfusion therapy similar to that of men. After adjustment with other covariates, women remained a significant variable to inhospital death.Journal of Nobel College of Medicine Vol.4(1) 2015: 6-11

The predictive Value of Total Neutrophil Count and Neutrophil/Lymphocyte Ratio in Predicting In-hospital Mortality and Complications after STEMI.

Introduction: Leukocytosis, predominantly neutrophilia, has previously been described following ST elevation myocardial infarction (STEMI). The exact contribution of this phenomenon to the clinical outcome of STEMI is yet to be shown. We examined cellular inflammatory response to STEMI in the blood and its association with in-hospital mortality and/or adverse clinical events. Methods: In this cross-sectional study, 404 patients who were admitted with the diagnosis of acute STEMI at Madani Heart Hospital from March 2010 to March 2012 were studied. The complete blood cell count (CBC) was obtained from all patientswithin12-24 hours of the onset of symptoms. Total leukocytes were counted and differential count was obtained for neutrophils, lymphocytes and neutrophil/lymphocyte ratio (NLR) were evaluated. Association of cellular response with the incidence of post-MI mortality/complications was assessed by multiple logistic regression analyses. Results: In-hospital mortality and post-STEMI complication rate were 3.7% and 43.6%, respectively. Higher age (P=0.04), female gender (0.002), lower ejection fraction (P<0.001) and absolute neutrophil count (P=0.04) were predictors of mortality. Pump failure in the form of acute pulmonary edema or cardiogenic shock occurred in 35 (8.9%) of patients. Higher leukocyte (P<0.03) and neutrophil counts (P<0.03) and higher NLR (P=0.01) were predictors of failure. The frequency of ventricular tachyarrhythmias (VT/VF) at the first day was associated with higher neutrophil count (P<0.001) and higher NLR level (P<0.001). In multivariate analysis neutrophil count was an independent predictor of mortality (OR=2.94; 1.1-8.4, P=0.04), and neutrophil count [OR=1.1, CI (1.01-1.20), P=0.02], female gender [OR=2.34, CI (1.02-4.88), P=0.04] and diabetes [OR=2.52, CI (1.21-5.2), P=0.003] were independent predictors of heart failure. Conclusion: A single CBC analysis may help to identify STEMI patients at risk for mortality and heart failure, and total neutrophil count is the most valuable in predicting both.

Changes in BNP, hs-CRP and TIMI risk index with addition of tirofiban during primary percutaneous coronary intervention for acute STEMI: a prospective observational cohort study

This study aimed to investigate the relationship of tirofiban, added to the treatment of acute ST-elevation myocardial infarction (STEMI) patients underwent primary percutaneous coronary intervention (PCI), with changes in the TIMI risk index (TRI) of TIMI flow, B-type natriuretic peptide (BNP) and high-sensitive C-reactive protein (hs-CRP) levels. This single-center, prospective observational cohort study included 102 consecutive patients who were admitted with the diagnosis of acute STEMI (70 male; 54.9±10.4 years). Primary PCI was applied to all cases with STEMI, who applied to our hospital in the first 6 hours due to chest pain complaints. Tirofiban was administered to one group (n=55) (male: 36; 54.1±11.3 years), while the other group was not given tirofiban (n=47) (male: 34; 55.9±9.1 years). The primary end-point was TIMI flow 2 or 3 for reperfusion after primary PCI. Chi-square test, paired t-test or Wilcoxon signed rank test, Spearman correlation analysis and Kaplan-Meier survival analysis were used for statistical analysis where appropriate. BNP level remained the same in the tirofiban group, whereas a significant increase was observed in the group that was not treated with tirofiban (105.9±126.8 versus 261.3±202.3 pg/ml p<0.001). The hs-CRP level tended to rise significantly in both groups despite the treatment (tirofiban group - from 0.67±0.66 to 0.90±0.44 mg/L, p=0.015, non tirofiban group - from 0.51±0.43 to 1.08±0.74 mg/L, p<0.001). BNP and hs-CRP values remained the same in cases with TIMI 2 flow in the tirofiban group, whereas a significant increase was detected in the post-treatment BNP (before 97.8±122.3 after 281.6±217.3 pg/ml, p=0.011) and hs-CRP (before 0.65±0.69; after 1.33±0.80 mg/L, p=0.028) values in the group not treated with tirofiban. In patients with TIMI 3 flow, BNP (tirofiban group before 146.5±114.2; after 184.4±139.4 pg/ml, p=0.011, non tirofiban group before 172.1±297.9; after 295.9±384.9 pg/ml, p<0.001) and hs-CRP levels (tirofiban group before 0.66±0.58; after 0.92±0.65 mg/L, p=0.011, non tirofiban group before 0.81±0.74; after 1.45±1.23 mg/L, p<0.001) were found to be similarly reduced in both treatment groups p<0.05. Three patients with minor hemorrhage did not need blood transfusion. It was concluded at the end of them PCI application in STEMI that the addition of tirofiban treatment in patients with ≥TIMI 2 flow and anterior location MI could decrease the expected rise in BNP and CRP values.