Inferior Myocardial Infarction Research Articles

Torsades De Pointes Complicating Acute Myocardial Infarction, Twisting the Prognosis

Introduction Torsades de pointes (TdP), a form of polymorphic ventricular tachycardia that manifests in the setting of an acquired or congenital QT interval prolongation. Polymorphic VT can occur in hyper acute phase or healing phase of an acute myocardial infarction. The presence of necrotic area caused by the infarction explains the existence of a possible circuit as well as the appearance of a re-entry arrhythmia. Aims and Objectives Our aim is to study the incidence of long Qt induced TdP in acute MI patients and its prognostic implications. We also want to analyze the impact of primary percutaneous transluminal coronary angioplasty in the management of these subset of patients. Methods In this cross-sectional observational study done from May 2021 to May 2022, We have studied 320 cases of acute MI, of which 6 were found to have TdP (1.9%). Four patients had inferior wall myocardial infarction and 2 patients had Non-ST elevation MI. Thrombolysis was done in 2 cases. Two cases underwent primary angioplasty. One case was recommended for coronary artery bypass grafting. All cases underwent appropriate electrolyte correction, besides cardioversion, as needed. Results All patients with TdP had prolonged QT interval. 50% of patients had mild hypokalemia. Two patients had complete heart block. Three patients had severe left ventricular dysfunction. Patients who underwent primary angioplasty survived. Thrombolysis had less impact on survival in Acute Mi with TdP. Conclusion Early percutaneous coronary angioplasty, combined with electrolyte correction, improves the prognosis in TdP complicating acute MI.

Combined Right and Left Ventricular Reperfusion Injury following Percutaneous Coronary Intervention: Role of Myocardial Contrast Echocardiography

Right ventricular myocardial infarction (RVMI) occurs in up to half of the patients of inferior wall myocardial infarction. RVMI results in edema and increased right ventricular (RV) mass, and hence, it should be possible to visualize microvascular obstruction as a manifestation of reperfusion injury. Reperfusion injury of the RV myocardium following primary percutaneous coronary intervention has been rarely reported. This report describes a patient with the left ventricular inferior and RVMI who showed echocardiographically detected reperfusion injury of the RV-free wall and left ventricular basal inferolateral wall and conformed by myocardial contrast perfusion study despite successful percutaneous revascularization of the right coronary artery.

Comprehensive assessment of the outcomes of inferior wall myocardial infarction according to echocardiography in patients after percutaneous coronary intervention

Aim. To identify significant echocardiographic parameters in the screening assessment of long-term outcomes of inferior wall myocardial infarction (MI) with primary percutaneous coronary intervention (PCI) using a logistic regression model.Material and methods. The study included the examination results of 144 people with inferior wall MI with primary PCI at admission, discharge and 6, 12, 24 months after discharge. Logistic regression analysis to identify screening outcomes of inferior wall MI included 184 variables, including 131 echocardiographic signs. Analysis of variance was performed using the ANOVA Type II method. The model quality was assessed using the likelihood ratio test and the Akaike criterion.Results. In patients with inferior wall MI and primary PCI, adverse outcomes were observed in 59,7% of cases in the form of repeated myocardial infarction and PCI, coronary artery bypass grafting, the development of stage 2 chronic heart failure, and/or rehospitalizations. For the long-term prognosis of inferior wall MI, in addition to left ventricular ejection fraction, mitral E/A, left atrial volume index and wall motion score index (WMSI), the following echocardiographic predictors were assessed: tricuspid S’ and e’, circumferential strain of the medial level, longitudinal strain of the apical and basal left ventricular levels, longitudinal strain of the segments included in the blood supply area of the circumflex artery.Conclusion. Echocardiographic parameters using Doppler and speckle-tracking technology have proven to be significant in screening outcomes of acute inferior wall MI with PCI.

Correlation between echocardiographic and primary percutaneous coronary intervention for proximal right coronary artery in inferior-wall myocardial infarction

Abstract Background Diagnosing myocardial infarction (MI) of the right ventricle (RV) is difficult. ECG remains the main tool for diagnosis of acute RVMI. For accurate diagnosis of RVMI, angiography can be done to enforce RVMI diagnosis. The physiology of the RV makes it less likely to suffer muscle infarction, but this can happen in cases of acute severe right coronary-artery (RCA) occlusion. Echocardiographic parameters have proven their efficacy in predicting proximal RCA infarction, including annular velocity and tricuspid annular-plane systolic excursion. Aim Assessment of the value of RV echocardiographic parameters in the diagnosis of early acute inferior RVMI in relation to coronary angiogram of proximal RCA. Patients and methods This prospective study was conducted on 125 patients diagnosed with inferior MI. ECG, echocardiographic RV parameters, and primary percutaneous coronary-intervention technique for proximal RCA were performed for all included patients at the Cardiovascular Medicine Department Tanta University Hospitals from June 2019 to December 2019. Results RV infarction occurred mostly in cases of proximal RCA occlusion and few cases with mid-segment of RCA lesion. This was reported by echocardiography using tricuspid annular-plane systolic excursion and S-wave tissue Doppler. Few cases showed impairment in RV function in left circumflex-artery occlusion as culprit vessel reported by echocardiography and the impairment occurred only with S wave. RV function was not affected with left circumflex-artery occlusion as culprit lesion. Conclusion Echocardiographic parameters of RV are useful in predicting RVMI due to proximal RCA occlusion.

Large Pulmonary Embolism With Paradoxical Embolism to a Coronary Artery Presenting as Inferior ST Elevation Myocardial Infarction, With Concomitant Compression of the Left Main Coronary Artery by a Dilated Main Pulmonary Artery

Large Pulmonary Embolism With Paradoxical Embolism to a Coronary Artery Presenting as Inferior ST Elevation Myocardial Infarction, With Concomitant Compression of the Left Main Coronary Artery by a Dilated Main Pulmonary Artery

A Curious Case of Acute STEMI in a Young Patient; Things are Not Always What They Seem

BACKGROUND: Acute myocardial infarction (MI) is a rare occurrence in patients under 40 years of age without positive family history for coronary artery disease (CAD). Genetic conditions as inherited thrombophilia can lead to a hypercoagulable state, resulting in thromboembolic events and arterial thrombosis. CASE SUMMARY: We present a case of a 35-year-old male patient who presented to the emergency room with an inferior MI after a strenuous cycling exercise. An urgent coronary angiography showed thrombotic formations in the right coronary artery without atherosclerotic plaques. Plain old balloon angioplasty and thrombus aspiration were performed, which was followed by GP IIb/IIIa inhibitor infusion and unfractionated heparin for 24 h. From past medical history, the patient had COVID-19 like symptoms 20 days before the event and had his first dose of anti- COVID vaccine 2 weeks prior. After additional testing, molecular genetic analysis results revealed the patient to be heterozygous for factor V Leiden (FVL) and homozygous for methylenetetrahydrofolate reductase C677T gene mutation. The patient was discharged on direct oral anticoagulant and antiplatelet therapy. After 1-year follow-up, he had no symptoms or recurrent cardiovascular events. CONCLUSION: Inherited thrombophilia is а significant risk factor for CAD and performing genetic testing in younger patients with a cardiovascular event and plays an important role for adequate treatment and prophylaxis from recurrent complications. The use of oral anticoagulation for prophylaxis is shown to be effective in these patients. However, further studies are needed to prove their exact role and duration of treatment.

Posteriyor mitral liflet prolapsusunun Fundaro anüloplasti ile onarımı: Sütür anüloplasti teknikleri cerraha yardımcı olabilir mi?

Aim
 Fundaro annuloplasty is a posterior leaflet repair technique developed for asymmetric tethering of mitral leaflets due to inferior myocardial infarction. ". In our study, we aimed to share our the operative and mid-term results of the fundaro annuloplasty technique.
 Material and Methods
 30 patients who underwent Fundaro annuloplasty for type 3b mitral regurgitation were included in the study. Fundaro annuloplasty with CABG was performed in 20 patients from this patient group, the remaining 10 patients underwent combined procedures. During the flollow-ups of the patients, physical examination, electrocardiography and transthoracic echocardiography were performed.
 Results
 The mean follow-up period of the patients included in the study was 35.8±20.3 months (min:1 max:59). According to the TEE datas performed intraoperatively, MR was not detected in 24 (80%) patients. The mean postoperative follow-up period of the patients was 35.8±20.3 months. During the follow-up period, recurrent MR was not observed in 23 (76.7%) patients. Mortality developed in 2 (6.7%) patients in the early postoperative period. Significant improvement was observed in their functional capacities(p

Electrocardiographic acute inferior myocardial infarction with right ventricle involvement due to acute thrombotic left anterior descending occlusion in a patient with atrial septal defect

Detecting the anatomic location of the lesion with the help of electrocardiography (ECG) is an important and time-saving decision in cases of acute ST-segment elevation myocardial infarction. However, it can be difficult in some patients with different coronary anatomies or underlying structural heart diseases. Here, we reported a 34-year-old male patient with an underlying atrial septal defect (ASD) who presented with acute inferior myocardial infarction with right ventricle (RV) involvement due to acute thrombotic left anterior descending artery occlusion.

Frequency of Right Ventricular Infarction in Patients with Acute Inferior Wall Myocardial Infarction Presenting At a Tertiary Care Hospital, Peshawar

Objectives: Right ventricular infraction has prognostic significance in the setting of acute “inferior wall myocardial infarction (IWMI)”, this research is intended to determine the frequency of “right ventricular infarction (RVI)” in patients with acute IWMI. Methodology: This descriptive cross-sectional study took place at a tertiary care hospital in Peshawar, Pakistan. The study included consecutive patients who were diagnosed with acute IWMI. The presence of RVI was determined based on specific ECG findings showing >1.0mm ST segment elevation on right-sided chest leads. Results: In a sample of 150 patients, 87 (58%) were male. The average age of the patients was 61 ± 10.7 years. Among the patients, 111 (74%) had hypertension, 64 (42.7%) were diabetic, and 45 (30%) were smokers. A body mass index (BMI) exceeding 25 kg/m2 was observed in 83 (55.3%) patients. RVI was observed in 62 (41.3%) of the patients. The occurrence of RVI did not show statistically significant differences between males and females (41.4% vs. 41.3%; p=0.989), hypertensive and non-hypertensive individuals (41.4% vs. 41.0%; p=0.964), diabetics and non-diabetics (42.2% vs. 40.7%; p=0.855), smokers and non-smokers (42.2% vs. 41.0%; p=0.885), and patients with BMI ≤25 kg/m2 and >25 kg/m2 (41.8% vs. 41.0%; p=0.920), respectively. Conclusion: Based on the research findings, it can be concluded that RVI is a relatively common occurrence in patients with acute IWMI, as it was observed in more than 40% of the patients studied. However, no statistically significant association exists between RVI and various demographic and clinical factors.

Outcomes of Late Presenters with Acute Inferior Wall Myocardial Infarction Complicated by Complete Heart Block Treated with Percutaneous Coronary Intervention

Objective: The objective of this study was to evaluate the outcomes of delayed presenters with acute inferior wall MI complicated by complete heart block treated by PCI of culprit artery. Methods: A descriptive cross-sectional study conducted on 40 patients with late presentation of either 48 hours or more with acute inferior wall MI complicated by complete heart block were included. All patients underwent coronary angiography and PCI of culprit vessel attempted. Outcomes were measured in terms of restoration of normal sinus rhythm along with heart block recovery time, requirement for implantation of permanent pacemaker and in hospital mortality. The statistical analysis was performed using SPSS 24. Results: The mean age was 55.73 ± 7.679. Male were 65% (n=26), diabetes 62.5% (n=25), hypertension 57.5 (n=23), smoking 30% (n=12) and dyslipidemia 52.5% (n=21). Mean delay in presentation 69.35 ± 11.132 hours. Mean restoration time 69.25 ± 10.95 hours, with minimum of 48 hrs & maximum 86 hrs. Mean tropinin I level 1588.97± 996.70 pg/ml. Mean Ejection fraction 44.8± 9.48 %. Successful PCI has a significant correlation with recovery time (p=.004). There was no in hospital mortality. All restores normal sinus rhythm and no patient needed permanent pacemaker. Successful PCI has a significant correlation with recovery time (p=.004). Conclusion: Successful PCI of culprit artery in late presenter of CHB with acute inferior MI results in restoration of NSR all patients with reduction in heart block recovery time and no in hospital death. Keywords: Acute inferior wall MI, Complete heart block, PCI, late presenter

Troponin and NT-proBNP in the prediction of impaired myocardial deformation after STEMI

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): University of Medicine and Pharmacy “Iuliu Hațieganu” Cluj- Napoca. Introduction One adverse consequence that may follow an ST-elevation myocardial infarction (STEMI) is left ventricular (LV) remodeling. The majority of evidence indicates speckle-tracking echocardiography and global longitudinal strain may identify early changes in deformation after MI, while circumferential strain (GCS) is less extensively studied. However, since strain is thought to be afterload-dependent, the global work index (GWI), a novel afterload-incorporating parameter recently evolved. Objective The aim of this study was to determine whether the levels of high-sensitive troponin and NT-proBNP, two variables known to be of prognostic significance in STEMI, might indicate whether GCS and GWI are more impaired after STEMI. Material and methods 60 patients with STEMI and preserved LVEF who underwent PCI were included in the study. Using a Vivid E95 scanner, early echocardiography (2–4 days) was performed, and the EchoPac BT13 software (GE Vingmed ultrasound) was used for analysis. Both conventional and deformation parameters were assessed. GWI was determined by using pressure-strain loops (strain and estimated LV pressure from the peak arterial brahial cuff pressure). ROC curves were used to determine the optimal cut-off values of Troponin and NT-proBNP to predict the values below the median for each of the studied parameters (GCS and GWI). Results The mean age of the patients was of 68±13 years and 55% were male. The majority of the patients presented with anterior MI (n=29, 48.3%), followed by inferior MI (n=25, 42%). Patients frequently reported hypertension (n=45,75%), while others had dyslipidemia (n=15, 25%), diabetes (n=8, 13.3%), and smoking (n=23, 38.3%) as cardiovascular risk factors. The median values of NT-proBNP were 600 [280–1930] pg/mL and 0.52 mg/dL [0.16–1.6] for troponin, respectively. Mean values of GCS were −11.6 ± 5.1% and of GWI were 927 ± 403 mmHg%. We analysed the ROC curves of troponin and NT-proBNP to predict values below the median of −10% for GCS and of 937mmHg% for GWI (Fig.1). We found that troponin values > 0.612 mg/dL (AUC 0.674, 95% CI 0.541 to 0.790, p = 0.014, Se 66%, Sp 71%) and NT-proBNP values > 715 pg/mL (AUC 0.678, 95 %CI 0.545 to 0.793, p = 0.0117, Se 59%, Sp 74%) were able to predict more impaired GWI. Interestingly, only troponin values > 0.315 mg/dL, a threshold that was lower than in the case of GWI, were able to predict more impaired GCS (AUC 0.755, 95% CI 0.627 to 0.857, p<0.0001, Se 91%, Sp 58%). Conclusion High sensitive troponin and NT-proBNP may indicate more impaired myocardial mechanics after STEMI. Both GCS and GWI, a parameter integrating strain and afterload, may provide additional information In the early stages of remodeling following MI.

Frequency of New Onset Atrial Fibrillation in Patients Presenting with ST-Segment Elevation Myocardial Infarction

Aim: To study the magnitude of atrial fibrillation in patients with ST segment elevation myocardial infarction. Study Design: Prospective analytic cross-sectional study. Place and duration of study: Department of Cardiology of a Tertiary Cardiac Care Center of Pakistan from 1st June 2022 to 30th November 2022. Methodology: Two hundred and thirty-six patients were selected through non-probability, consecutive sampling technique. Patients were divided into Group 1 who did not develop AF while group 2 included the new cases of AF during in-hospital stay for STEMI. All patients underwent clinical examinations, echocardiography, angiography and percutaneous coronary intervention. Results: Forty five cases with an average age of 71±14 years developed atrial fibrillation. Female population 25(60%) was at higher risk than male 17(40%). In AF group, 22(53.3%) cases of dyslipidemia, 11(26.1%) cases of chronic renal disease, 4(8.8%) cases of prior myocardial infarction, 14(33.3%) cases of diabetes and a single case (2.2%) of implantable cardiac-defibrillator were observed when compared with the non-AF group. Practical Implication: In-hospital complications are also highly associated with AF which may result in high Incidents of mortality. Conclusion: Aging, comorbidities and inferior wall MI are the independent predictors of AF. In-hospital complications are associated with AF which may result in high incidents of mortality. Early diagnosis of STEMI patients with a high risk of developing AF is necessary to reduce the morbidity and mortality. Keywords: Atrial fibrillation, ST-segment elevation, Myocardial infarction

Culprit Arteries in Patients with Inferior Wall Myocardial Infarction (IWMI) With St Segment Depression in Lead AVR

ACS is an imbalance between the myocardial oxygen demand and consumption of oxygen by the heart. While coronary plaque rupture, which results in STEMI, is almost always the cause of this mismatch development of thrombus blocking a coronary artery. Objective: To determine the frequency of culprit arteries in patients with inferior wall myocardial infarction (IWMI) with ST Segment depression in Lead AVR. Methods: This cross sectional study was conducted at Department of Adult Cardiology, NICVD, Karachi, Pakistan from November 4, 2020 to May 3, 2021. All patients who fulfilled the inclusion criteria were enrolled and consent was taken. All patients were initially stabilized and then were prepared for coronary angiography. Interpretation of coronary angiogram was done to assess the culprit arteries i.e. LCX, RCA. Data were collected in proforma. Results. Out of 317 patients, 233 (73.5%) were male while 84 (26.5%) were female with mean age of 51.4±12.4 years. Left circumflex coronary artery was found in 184 (58%) patients. Right coronary artery was found in 133 (42%) patients. Conclusions: This study concludes that LCX artery is more likely to be culprit in patients with inferior wall myocardial infarction and ST-segment depression in lead AVR. STEMI patients with IWMI should be worked up for the presence of culprit arteries to ensure adequate treatment

The importance of the right ventricular insertion area for the functional substrate of ventricular tachycardia after myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Background Conducting systematic annotation and ablation of evoked delayed potentials (EDP) in response to short coupled right ventricular extra-stimuli (RV-ES) has improved ablation outcome of post myocardial infarction (MI) ventricular tachycardia (VT). The reported short radiofrequency catheter ablation (RFCA) times suggests the presence of predilection areas for these functional substrates. Purpose To evaluate the electroanatomical characteristics and distribution of EDPs in post-MI patients referred for RFCA of VT. Methods Electroanatomical mapping (EAM) data of 48 post-MI patients (69 ± 9 years, 39 male, LV ejection fraction 36 ± 10%, anterior MI 20 [42%], inferior MI 28 [58%]), who underwent functional substrate mapping and ablation were analyzed. Pre-procedural cardiac CTs of 16 patients (8 anterior, 8 inferior MI) were integrated with EAM data. Infarct extension (defined as bipolar voltage [BV] <3.0mV, dense scar <0.5mV and scar borderzone [BZ] 0.5-3mV) and EDP location were determined based on the AHA 17-segment model of the left ventricle. Results RV-ES was performed during mapping at 2180 LV sites (median 46 per patient, range 8-81) and EDPs were observed at 631 (29%) sites. Patients had a median of 11 (range 1-37) EDP sites. Compared to no-EDP sites, EDP sites had lower BV (median 0.57 mV vs. 0.77 mV, P <0.001), longer duration (median 79 ms vs. 66 ms, P <0.001), and larger number of positive sharp deflections (median 6 vs. 5, P <0.001) during sinus rhythm. Of all EDP sites, 278 (44%), 286 (45%), 64 (10%), and 3 (1%) had BV of <0.5mV, ≥ 0.5mV and <1.5 mV, a BV of ≥1.5 mV and <3.0 mV, and a BV of >3.0 mV, respectively. In the 16 patients with CT image integration, a total of 124/272 segments showed EA scar with a median (IQR, range) of 8 (6-9, 4-12) segments per patient. Any EDP was identified in 71/124 (57%) of segments with EA scar. Of note, 73% of all EDPs in inferior MIs and 64% of all EDPs in anterior MI were located in 4 AHA segments, namely 3,4, 9,10 and 7,8,13,14, respectively, close to the inferior or anterior RV insertion. Such a cluster of EDP sites around the RV insertion was found in 6 (75%) patients with inferior MI and in 7 (88%) patients with anterior MI. Conclusion About 10% of EDPs are identified at sites with BV of ≥1.5mV and <3.0mV during sinus rhythm supporting the recently proposed BV threshold <3.0mV for post-MI scars. EDPs are frequently located near the RV insertion in both inferior MI and anterior MI suggesting a role of the RV insertion in the functional substrate of post-MI VT.

St-elevation myocardial infarction in a healthy 16-year-old adolescent: a clinical case

Background. Diagnosis of acute myocardial infarction (AMI) in pubertal patients is a diagnostic challenge, as individuals of such a young age usually do not have traditional risk factors for coronary heart disease (CHD) and, as a result, are at increased risk of misdiagnosis.Objective. To describe a clinical case of AMI in a 16-yearold patient against the background of complete well-being.Design and methods. A 16-year-old patient, against the background of complete well-being, developed pressing pains in the chest, which stopped on their own after a few hours. During hospitalization, in addition to an increase in the level of troponin, the results of other laboratory and instrumental studies did not confirm the version of AMI, as a result of which other cardiac and non-cardiac causes of the development of chest pain formed the basis of the diagnostic search. This was the reason for the delayed diagnosis and endovascular treatment of thrombotic occlusion of the right coronary artery, and, as a result, the formation of an area of persistent hypokinesia of the lower parts of the left ventricle. Further search for possible causes of AMI, including the analysis of genetically associated conditions, did not yield results.Results. This publication describes a case of acute inferior myocardial infarction with ST segment elevation and thrombotic occlusion of the right coronary artery in a 16-year-old adolescent and the impact of an irrational diagnostic process on long-term prognosis.Conclusion. The presented clinical case demonstrates the importance of including the diagnosis of AMI in the process of differential diagnosis of acute chest pain, even in adolescent patients.

Develop a risk stratification model and clinical analysis to predict the impact of primary percutaneous coronary intervention on complete AV block in acute inferior STEMI patients

Background: Acute inferior ST-elevation myocardial infarction (STEMI) is medical emergency entailing immediate intervention to restore blood flow and mitigate myocardial damage. Primary percutaneous coronary intervention (PCI) has replaced thrombolytic therapy as preferred treatment strategy for having superior outcomes. Objectives: To develop a risk stratification model incorporating the identified predictors to estimate the individual risk of complete AV block in patients undergoing primary PCI for acute inferior STEMI. Methods: This study enrolled 139 patients diagnosed with acute inferior STEMI who underwent primary PCI at the hospital. They were divided into two groups, i.e. pre-operative and post-operative carrying 54 and 85 patients, respectively. On admission, demographic, clinical data and peak values of cardiac biomarkers were obtained and the complications associated with PCI were elaborated. Results: Mean age of patients was 59.81+8.19 years, and comprised significantly more male (97) than female (42) patients (p<0.05). Proportion of patients with a history of complete AV block was 10.79%. Comorbidities included diabetes mellitus (33.09%), hypertension (49.64%), and dyslipidemia (64.74%).Coronary angiography findings for predicting AV block in patients with STEMI were categorized by location of culprit lesion in coronary vessels.

Hemodynamical consequences and tolerance of sustained ventricular tachycardia.

Factors underlying clinical tolerance and hemodynamic consequences of monomorphic sustained ventricular tachycardia (VT) need to be clarified. Intra-arterial pressures (IAP) during VT were collected in patients admitted for VT ablation and correlated to clinical, ECG and baseline echocardiographical parameters. 114 VTs from 58 patients were included (median 67 years old, 81% ischemic heart disease, median left ventricular ejection fraction 30%). 61 VTs were untolerated needing immediate termination (54%). VT tolerance was tightly linked to the evolution of IAPs. Faster VT rates (p<0.0001), presence of resynchronization therapy (p = 0.008), previous anterior myocardial infarction (p = 0.009) and more marginally larger baseline QRS duration (p = 0.1) were independently associated with VT tolerance. Only an inferior myocardial infarction was more often present in patients with only tolerated VTs vs patients with only untolerated VTs in multivariate analysis (OR 3.7, 95% CI 1.4-1000, p = 0.03). In patients with both well-tolerated and untolerated VTs, a higher VT rate was the only variable independently associated with untolerated VT (p = 0.02). Two different patterns of hemodynamic profiles during VT could be observed: a regular 1:1 relationship between electrical (QRS) and mechanical (IAP) events or some dissociation between both. VT with the second pattern were more often untolerated compared to the first pattern (78% vs 29%, p<0.0001). This study helps to explain the large variability in clinical tolerance during VT, which is clearly related to IAP. VT tolerance may be linked to resynchronization therapy, VT rate, baseline QRS duration and location of myocardial infarction.

Acute compartment syndrome of the forearm after trans-radial approach to percutaneous coronary intervention: a case report

Percutaneous coronary intervention (PCI) through transradial pathway is associated with lower risk of severe vascular problems comparing to transfemoral. It is reported that the acute compartment syndrome (ACS) in forearm is significant lower comparing to leg. A 47 y.o. male with ACS following a transradial approach of PCI due to inferior myocardial infarction was reported. The patient experienced pain and swelling in his right forearm for 7 hr after the procedure and was later brought to hospital and treated with emergency of fasciotomy. The patient showed good post-fasciotomy recovery on the first 2 wk and showed good DASH score after 4 wk. Quick diagnosis with prompt treatment makes a better outcome for the patient. Consequently, a high level of awareness to make the diagnosis as quickly and accurately management as possible could prevent morbidity caused by late and unrecognized management compartment syndrome eventually could make a better clinical outcome.

30 day outcome after early discharge in low risk ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Current guidelines for management of patients with ST-segment elevation myocardial infarction (STEMI) encourage an early discharge (48-72 h) after a successful primary percutaneous coronary intervention (PCI) in selected low risk patients. Yet, this strategy is not routinely applied. The evidence on the relative outcome of patients discharged early compared to those discharged later, has been limited. Purpose To assess safety of early discharge in low risk STEMI patients treated with primary PCI by analyzing 30 days outcomes relative to early and late discharge strategies. Methods We prospectively enrolled 109 patients presented with STEMI from April 2019 to September 2019, who were categorized as low risk according to Zwolle risk score. 60 (55%) patients were discharged after 48-72 hours and 49 (45%) after &amp;gt; 72 hours. We gathered clinical data at 30 days. Primary endpoints were occurrence of a major adverse event - a composite of death from any cause, nonfatal myocardial infarction and acute stent thrombosis. Secondary endpoints were acute angina and re-hospitalization. Results The mean age was 59.7 +/- 10.5 years in early discharge group compared to 62.8 +/- 10.5 years in late discharge group (p=0.132). 88 (80.7%) patients were male. 58 (53.2%) of them had inferior MI. Mean ejection fraction was 49.25% +/- 4.95%. Median symptom to balloon time was 9.3 +/- 6.7 hour. Median length of stay was 3.4 days +/-0.6. Primary endpoint occurred in one patient in the early discharge group, who had acute stent thrombosis and nonfatal myocardial infarction. No death from any cause was observed in both groups. Secondary endpoint occurred in 3 patients who had acute angina, 2 in late discharge group and 1 in early discharge group. Conclusion(s) Data from our study reveal that an early discharge strategy in selected low risk STEMI patients treated with successful primary PCI is not associated with a significant increase in major adverse events compared to late discharge strategy.

Towards practical evaluation and development of AI for ECG interpretation

Obtaining a right-chest electrocardiogram is essential for diagnosing concomitant right ventricular infarction in patients with inferior wall acute myocardial infarctions. A software program to synthesize right-chest electrocardiographic waveforms from 12-lead electrocardiographic waveforms is available in Japan. However, its reliability has not been fully investigated. Accordingly, the aim of this study was to examine the reliability of ST-segment shifts in the synthesized V3R to V5R leads. ST-segment shifts in actual and synthesized V3R to V5R leads were compared during the last 10 seconds of 131 balloon inflations while performing elective percutaneous coronary intervention in 56 patients with coronary artery disease. ST-segment shifts in the actual and synthesized V3R, V4R, and V5R leads were correlated (r = 0.96, p <0.001, r = 0.94, p <0.001, and r = 0.91, p <0.001, respectively). A Bland-Altman analysis showed that the bias between ST-segment shifts in the actual and synthesized V3R to V5R leads was −3.1, −5.4, and −4.2 μV, respectively, while the limits of agreement between the ST-segment shifts in the actual and synthesized V3R to V5R leads were −59.2 to 52.9, −61.9 to 51.1, and −59.7 to 51.3 μV, respectively. The κ coefficients for ST-segment elevation of ≥50 and ≥100 μV in the actual and synthesized V3R, V4R, and V5R leads were 0.83 and 0.81, 0.66 and 0.83, and 0.57 and 0.80, respectively. In conclusion, these results indicate that ST-segment shifts in the synthesized V3R to V5R leads have acceptable reliability, suggesting that synthesized right-chest electrocardiography can be used to diagnose concomitant right ventricular infarction in patients with inferior wall acute myocardial infarctions.