ST-segment Elevation Myocardial Infarction Cases Research Articles

Dressler - de Winter sign with acute inferoposterior STEMI: An ECG dilemma in artery localization

The Dressler-de Winter sign is an electrocardiogram (ECG) pattern characterized by upsloping ST-segment depression in leads V1-V6 followed by tall, hyperacute T waves, typically indicating an occlusion of the left anterior descending artery (LAD). We present a case involving an inferoposterior ST-segment elevation myocardial infarction (STEMI) with a variant of the de Winter sign, a concept of ST-segment continuum in the precordial leads. Despite initial ECG findings suggesting right coronary artery (RCA) or left circumflex artery (LCX) involvement, coronary angiography confirmed occlusion of the wrap-around LAD distal to the first septal (S1) and diagonal branch (D1) and revealed a left dominant system accompanied by a small non-dominant RCA. This case highlights the diagnostic complexity in accurately localizing the culprit artery in STEMI cases exhibiting the de Winter sign. Understanding such ECG variants is crucial for analyzing the mechanisms of acute ischemia and ensuring accurate assessment of the culprit vessel for effective revascularization.

Advancements in reperfusion rates and quality of care for ST-segment elevation myocardial infarction: a ten-year evaluation of Salvador's STEMI network.

Continuous investment and systematic evaluation of program accomplishments are required to achieve excellence in ST-segment elevation myocardial infarction (STEMI) care, especially in resource-limited settings. Therefore, this study evaluates the impact of problem-driven interventions on reperfusion use rate in a long-term operating STEMI network from a low- to middle-income country. This is a healthcare improvement evaluation study of Salvador's public STEMI network in a quasi-experimental design, comparing data from 2009 to 2010 (pre-intervention) and 2019-2020 (post-intervention). There were evaluated all confirmed STEMI cases assisted in both periods. The interventions, implemented since 2017, included: expanding the support team, defining criteria to be a spoke, and initiating continuous education activities. The primary outcome was the rate of patients undergoing reperfusion, with secondary outcomes being time from door-to-ECG (D2E) and ECG-to-STEMI-team trigger (E2T). Over ten years, the network's coverage increased by 300,000 individuals, and expanded by 1,800 km2. A total of 885 records were analyzed, 287 in the pre-intervention group (182 men [63·4%]; mean [SD] age 62·1 [12·5] years) and 598 in the post-intervention group (356 men [59·5%]; mean [SD] age 61.9 [11·8] years). It was noticed a substantial increase in reperfusion delivery rate (90 [31%] vs. 431 [73%]; P = 001) and reductions in time from D2E (159 [83-340] vs. 29 [15-63], P = 001), and E2T (31 [21-44] vs. 16 [6-40], P = 001). The strategies adopted by Salvador's STEMI network were associated with significant improvements in the rate of patients undergoing reperfusion and in D2E and E2T. However, the mortality rate remains high.

Anterior-wall and non-anterior-wall STEMIs do not differ in long-term mortality: results from the augsburg myocardial infarction registry.

Different ST-segment elevation myocardial infarction (STEMI) localizations go along with dissimilarities in the size of the affected myocardium, the causing coronary vessel occlusion, and the right ventricular participation. Therefore, this study aims to clarify if there is any difference in long-term survival between anterior- and non-anterior-wall STEMI. This study included 2,195 incident STEMI cases that occurred between 2009 and 2017, recorded by the population-based Augsburg Myocardial Infarction Registry, Germany. The study population comprised 1.570 men and 625 women aged 25-84 years at acute myocardial infarction. The patients were observed from the day of their first acute event with an average follow-up period of 4.3 years, (standard deviation: 3.0). Survival analyses and multivariable Cox regression analyses were performed to examine the association between infarction localizations and long-term all-cause mortality. Of the 2,195 patients, 1,118 had an anterior (AWS)- and 1,077 a non-anterior-wall-STEMI (NAWS). No significant associations of the STEMI localization with long-term mortality were found. When comparing AWS with NAWS, a hazard ratio of 0.91 [95% confidence interval: 0.75-1.10] could be calculated after multivariable adjustment. In contrast to NAWS, AWS was associated with a greater <28 day mortality, less current or former smoking and higher creatine kinase-myocardial band levels (CK-MB) and went along with a higher frequency of impaired left ventricular ejection fraction (<30%). Despite pathophysiological differences between AWS and NAWS, and identified differences in multiple clinical characteristics, no significant differences in long-term mortality between both groups were observed.

Correlation of Serum Neutrophil Gelatinaseassociated Lipocalin with Clinical Severity Score in Patients with Acute Coronary Syndrome: A Cross-sectional Study

Introduction: Acute Coronary Syndrome (ACS) is a term that encompasses various clinical presentations such as ST-Segment Elevation Myocardial Infarction (STEMI), Non STEMI (NSTEMI), or unstable angina. Neutrophil Gelatinase-associated Lipocalin (NGAL), also known as lipocalin-2, belongs to the lipocalin category of extracellular proteins. Recent research indicates that NGAL levels are increased in different cardiac situations, regardless of the presence of acute renal injury. Aim: To compare the levels of serum NGAL and Global Registry of Acute Coronary Events (GRACE) scores between cases with ACS and Angio-negative cases, and to study the correlation of serum NGAL with the GRACE score (clinical severity score) in ACS patients. Materials and Methods: A cross-sectional study was conducted with 128 patients at the Department of Biochemistry, MKCG Medical College and Hospital, Berhampur, Odisha, India, presenting to the Cardiac Emergency Department from November 2020 to August 2021. Coronary Angiograms (CAG) were done to confirm the presence of Coronary Artery Disease (CAD), and patients were grouped accordingly as Group-1 with ACS patients and Group-2 with angiogram-negative cases. Apart from the routine work-up, including serum urea and creatinine, serum electrolytes, fasting blood sugar, lipid profile, and management, all patients underwent determination of serum NGAL levels and GRACE score at admission. The data were analysis using student’s t-test and Pearson’s correlation test. Results: Among the 128 participants (64 cases in Group-1 and 64 cases in Group-2), Group-1 comprised 37 cases of STEMI, 26 cases of NSTEMI, and one case of unstable angina. Serum NGAL levels were significantly elevated in patients with CAGproven ACS (140.89±56.47 ng/mL) without any renal dysfunction, sepsis, or overt infection compared to patients without CAD on CAG (52.01±18.39 ng/mL) (p&lt;0.0001). The serum NGAL level exhibited a positive correlation of 0.359 (p=0.004) with the severity of ACS, as measured by the GRACE score. Conclusion: The present study suggests that serum NGAL in patients with ACS may serve as a potential novel biomarker for risk stratification and predicting the severity of the disease.

The Clinical and Economic Impact of Delayed Reperfusion Therapy: Real-World Evidence.

Early reperfusion therapy is acknowledged as the most effective approach for reducing case fatality rates in patients with ST-segment elevation myocardial infarction (STEMI). Estimate the clinical and economic consequences of delaying reperfusion in patients with STEMI. This retrospective cohort study evaluated mortality rates and the total expenses incurred by delaying reperfusion therapy among 2622 individuals with STEMI. Costs of in-hospital care and lost productivity due to death or disability were estimated from the perspective of the Brazilian Unified Health System indexed in international dollars (Int$) adjusted by purchase power parity. A p < 0.05 was considered statistically significant. Each additional hour of delay in reperfusion therapy was associated with a 6.2% increase (95% CI: 0.3% to 11.8%, p = 0.032) in the risk of in-hospital mortality. The overall expenses were 45% higher among individuals who received treatment after 9 hours compared to those who were treated within the first 3 hours, primarily driven by in-hospital costs (p = 0.005). A multivariate linear regression model indicated that for every 3-hour delay in thrombolysis, there was an increase in in-hospital costs of Int$497 ± 286 (p = 0.003). The findings of our study offer further evidence that emphasizes the crucial role of prompt reperfusion therapy in saving lives and preserving public health resources. These results underscore the urgent need for implementing a network to manage STEMI cases.

Predictor of No-Reflow in Patients With ST-Segment Elevation Myocardial Infarction.

We have carefully read the article titled 'Prognostic Nutritional Index as a Predictor of No-Reflow Occurrence in Patients With ST-Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention' and find it to be of significant interest. The no-reflow phenomenon (NRP) stands as a formidable complication of ST-segment elevation myocardial infarction (STEMI), carrying a high mortality risk. Managing NRP entails pharmacological and mechanical interventions, making its prediction a crucial aspect in the management of STEMI cases. We extend our gratitude to you and the authors for conducting this valuable and thought-provoking study. We anticipate that our insights will serve as a guide for future comprehensive studies in this dynamic area.

The France PCI registry: Design, methodology and key findings

Obstructive coronary artery disease is the main cause of death worldwide. By tracking events and gaining feedback on patient management, the most relevant information is provided to public health services to further improve prognosis. To create an inclusive and accurate registry of all percutaneous coronary intervention (PCI) procedures performed in France, to assess and improve the quality of care and create research incentives. Also, to describe the methodology of this French national registry of interventional cardiology, and present early key findings. The France PCI registry is a multicentre observational registry that includes consecutive patients undergoing coronary angiography and/or PCI. The registry was set up to provide online data analysis and structured reports of PCI activity, including process of care measures and assessment of risk-adjusted outcomes in all French PCI centres that are willing to participate. More than 150 baseline data items, describing demographic status, PCI indications and techniques, and in-hospital and 1-year outcomes, are captured into local reporting software by medical doctors and local research technicians, with subsequent encryption and internet transfer to central data servers. Annual activity reports and scoring tools available on the France PCI website enable users to benchmark and improve clinical practices. External validation and consistency assessments are performed, with feedback of data completeness to centres. Between 01 January 2014 and 31 December 2022, participating centres increased from six to 47, and collected 364,770 invasive coronary angiograms and 176,030 PCIs, including 54,049 non-ST-segment elevation myocardial infarction cases and 31,631 ST-segment elevation myocardial infarction cases. Fifteen studies stemming from the France PCI registry have already been published. This fully electronic, daily updated, high-quality, low-cost, national registry is sustainable, and is now expanding. Merging with medicoeconomic databases and nested randomized scientific studies are ongoing steps to expand its scientific potential.

Evaluation of the success of shock index and its derivatives in determining mortality in STEMI cases applied to emergency department

Objectives: The shock index (SI) and its derivatives play a crucial role in rapid prognosis and risk assessment, particularly in emergent scenarios like ST-segment elevation myocardial infarction (STEMI). Methods: This study was conducted as a single-centered retrospective. A total of 467 cases that met the study criteria with a confirmed STEMI diagnosis were included. The SI, modified SI (MSI), age SI (ASI), and age-modified SI (AMSI) scores of the cases were calculated and compared. In this study, p 0.05 was accepted as the statistical significance level. Results: Calculated scores were compared among cases meeting STEMI criteria. Mortal cases displayed significantly higher SI, MSI, ASI, and AMSI, as well as elevated heart rates and lowered SBP, DBP, and MAP values. ASI exhibited the highest predictive success for mortality (AUC: 0.802), followed by AMSI (AUC: 0.798). AMSI demonstrated superior significance in estimating major adverse cardiovascular events (MACE) (p &amp;lt; 0.001 for each parameter). Conclusions: ASI proved most effective in gauging mortality risk, while AMSI excelled in predicting MACE risk among SI derivatives. These indices hold promise for guiding patient triage and emergency care in STEMI cases, owing to their simplicity and predictive capacity.

Readmissions for Myocardial Infarction Among Survivors of COVID-19 Hospitalization: Nationwide Analysis From Pandemic Year 2020

BackgroundCOVID-19 is known to be associated with acute myocardial infarction (MI). ObjectivesThe purpose of this study was to evaluate the outcomes of 30-day readmissions for MI among survivors of COVID-19 hospitalization. Methods and ResultsWe used the U.S. Nationwide Readmission Database to identify COVID-19 admissions from April 1, 2020, to November 30, 2020, using International Classification of Diseases-10th Revision-Clinical Modification (ICD-10-CM) claims. The primary outcome was 30-day readmission incidence for MI. A total of 521,251 cases of COVID-19 were included, of which 11.6% were readmitted within 30 days of discharge. The 30-day readmission incidence for MI was 0.6%. The 30-day all-cause readmission mortality incidence was 1.3%. Patients readmitted for MI were more frequently males (61.6% vs 38.4%) and had a higher Charlson comorbidity burden score (7 vs 4). The most common diagnosis among 30-day MI readmission was type 2 MI (51.1%), followed by a diagnosis of a type 1 non-ST-segment elevation MI (41.7%). ST-segment elevation MI cases constituted 7.6% of all MI-readmission whereas 0.6% of patients had unstable angina. 30-day MI readmissions with a recurrent diagnosis of COVID-19 had higher readmission mortality and incidence of complications. Conversely, the odds of performing revascularization procedures were lower for MI with recurrent COVID-19. Furthermore, MI readmissions with recurrent COVID-19 had a higher length of stay (7 vs 5 days) and cost of hospitalization ($18,398 vs $16,191) when compared with non-COVID-19 MI readmissions. ConclusionsAmong survivors of COVID-19 hospitalization, 5.2% of all-cause 30-day readmissions and 12% of all-cause readmission mortality were attributed to MI. MI-related readmissions were a significant source of mortality, morbidity, and resource utilization.

ECG criteria to distinguish hypertrophic cardiomyopathy featured with “Pseudo-STEMI” from acute ST-elevation myocardial infarction

BackgroudThe ECG profile of Hypertrophic Cardiomyopathy (HCM) includes ST-segment elevation (STE) that may lead to misdiagnosis of acute ST-segment elevation myocardial infarction (STEMI). This pseudo-STEMI may bring non-essential treatment. We aimed to confirm the ECG differences between HCM featured with pseudo-STEMI and acute STEMI. Material and methodsWe retrospectively enrolled 59 HCM cases (Group A) and 56 acute STEMI cases (Group B). Based on the locations of STE, all the patients were divided into four subgroups, including HCM with STE in anterior leads (Group A1), anterior STEMI (Group B1), HCM with STE in inferior leads (Group A2) and inferior STEMI (Group B2). Several ECG parameters were compared between these subgroups. ResultsECG parameters significantly differed between these groups, especially the number of leads with TWI. We evaluated the diagnostic value of ECG profiles for those groups. ROC analysis showed that for Group A vs. Group B, number of leads with TWI showed the highest AUC value of 0.805 and its cutoff of 2.5, with 76.3% sensitivity and 76.8% specificity. For Group A1 vs. Group B1, it showed the highest AUC value of 0.801 and its cut-off point was 2.5, with 77.1% sensitivity and 79.1% specificity. For Group A2 vs. Group B2, it showed the highest AUC value of 0.822 and the cut-off value was 4.5, with 54.5% sensitivity and 92.3% specificity. ConclusionECG plays a valid tool to distinguish “Pseudo-STEMI” HCM from acute STEMI, especially number of leads with TWI.

Predictors in no-reflow phenomenon in acute myocardial infarction with ST-segment elevation.

No-reflow (NR) phenomenon is one of the most feared complications after percutaneous coronary intervention (PCI) in the treatment of ST-segment elevation myocardial infarction (STEMI) due to its high morbidity and mortality. To describe the predictive factors for NR phenomenon in a group of subjects with STEMI treated with PCI. One hundred and three cases of STEMI who underwent PCI. The subjects were divided according to the presence of NR phenomenon. In a multivariate analysis age, gender, comorbidities, weight, and other clinical and laboratory parameters were studied as predictors of NR phenomenon were studied. In this study, logistic regression analysis identified as independent factors for the development of NR phenomenon baseline TIMI flow ≤ 2 (OR 6.03; 95% CI, 0.9 to 11.8; p = 0.04), ER KDIGO ≥ 3 (OR OR 2.61; 95% CI, 1.0 to 2.4; p = 0.04). NR phenomenon continues to be a challenge for short and long-term morbidity and mortality in STEMI. The identified factors can be used for the stratification of cases with STEMI and risk of NR phenomenon prior to PCI.

Clinical Validation of the Shock Index, Modified Shock Index, Delta Shock Index, and Shock Index-C for Emergency Department ST-Segment Elevation Myocardial Infarction.

Background: ST-segment elevation myocardial infarction (STEMI) is a leading cause of death worldwide. A shock index (SI), modified SI (MSI), delta-SI, and shock index-C (SIC) are known predictors of STEMI. This retrospective cohort study was designed to compare the predictive value of the SI, MSI, delta-SI, and SIC with thrombolysis in myocardial infarction (TIMI) risk scales. Method: Patients > 20 years old with STEMI who underwent percutaneous coronary intervention (PCI) were included. Receiver operating characteristic (ROC) curve analysis with the Youden index was performed to calculate the optimal cutoff values for these predictors. Results: Overall, 1552 adult STEMI cases were analyzed. The thresholds for the emergency department (ED) SI, MSI, SIC, and TIMI risk scales for in-hospital mortality were 0.75, 0.97, 21.00, and 5.5, respectively. Accordingly, ED SIC had better predictive power than the ED SI and ED MSI. The predictive power was relatively higher than TIMI risk scales, but the difference did not achieve statistical significance. After adjusting for confounding factors, the ED SI > 0.75, MSI > 0.97, SIC > 21.0, and TIMI risk scales > 5.5 were statistically and significantly associated with in-hospital mortality of STEMI. Compared with the ED SI and MSI, SIC (>21.0) had better sensitivity (67.2%, 95% CI, 58.6–75.9%), specificity (83.5%, 95% CI, 81.6–85.4%), PPV (24.8%, 95% CI, 20.2–29.6%), and NPV (96.9%, 95% CI, 96.0–97.9%) for in-hospital mortality of STEMI. Conclusions: SIC had better discrimination ability than the SI, MSI, and delta-SI. Compared with the TIMI risk scales, the ACU value of SIC was still higher. Therefore, SIC might be a convenient and rapid tool for predicting the outcome of STEMI.

Current recommendations for revascularization of non-infarct-related artery in patients presenting with ST-segment elevation myocardial infarction and multivessel disease.

ST-segment elevation myocardial infarction (STEMI) is a leading cause of morbidity and mortality worldwide. Immediate reperfusion therapy of the infarct-related artery (IRA) is the mainstay of treatment, either via primary percutaneous coronary intervention (PPCI) or thrombolytic therapy when PPCI is not feasible. Several studies have reported the incidence of multivessel disease (MVD) to be about 50% of total STEMI cases. This means that after successful PPCI of the IRA, residual lesion(s) of the non-IRA may persist. Unlike the atherosclerotic plaque of stable coronary artery disease, the residual obstructive lesion of the non-IRA contains a significantly higher prevalence of vulnerable plaques. Since these lesions are a strong predictor of acute coronary syndrome, if left untreated they are a possible cause of future adverse cardiovascular events. Percutaneous coronary intervention (PCI) of the obstructive lesion of the non-IRA to achieve complete revascularization (CR) is therefore preferable. Several major randomized controlled trials (RCTs) and meta-analyses demonstrated the clinical benefits of the CR strategy in the setting of STEMI with MVD, not only for enhancing survival but also for reducing unplanned revascularization. The CR strategy is now supported by recently published clinical practice guidelines. Nevertheless, the benefit of revascularization must be weighed against the risks from additional procedures.

A Deep Learning Algorithm for Detecting Acute Pericarditis by Electrocardiogram.

(1) Background: Acute pericarditis is often confused with ST-segment elevation myocardial infarction (STEMI) among patients presenting with acute chest pain in the emergency department (ED). Since a deep learning model (DLM) has been validated to accurately identify STEMI cases via 12-lead electrocardiogram (ECG), this study aimed to develop another DLM for the detection of acute pericarditis in the ED. (2) Methods: This study included 128 ECGs from patients with acute pericarditis and 66,633 ECGs from patients visiting the ED between 1 January 2010 and 31 December 2020. The ECGs were randomly allocated based on patients to the training, tuning, and validation sets, at a 3:1:1 ratio. We used raw ECG signals to train a pericarditis-DLM and used traditional ECG features to train a machine learning model. A human–machine competition was conducted using a subset of the validation set, and the performance of the Philips automatic algorithm was also compared. STEMI cases in the validation set were extracted to analyze the DLM ability of differential diagnosis between acute pericarditis and STEMI using ECG. We also followed the hospitalization events in non-pericarditis cases to explore the meaning of false-positive predictions. (3) Results: The pericarditis-DLM exceeded the performance of all participating human experts and algorithms based on traditional ECG features in the human–machine competition. In the validation set, the pericarditis-DLM could detect acute pericarditis with an area under the receiver operating characteristic curve (AUC) of 0.954, a sensitivity of 78.9%, and a specificity of 97.7%. However, our pericarditis-DLM also misinterpreted 10.2% of STEMI ECGs as pericarditis cases. Therefore, we generated an integrating strategy combining pericarditis-DLM and a previously developed STEMI-DLM, which provided a sensitivity of 73.7% and specificity of 99.4%, to identify acute pericarditis in patients with chest pains. Compared to the true-negative cases, patients with false-positive results using this strategy were associated with higher risk of hospitalization within 3 days due to cardiac disorders (hazard ratio (HR): 8.09; 95% confidence interval (CI): 3.99 to 16.39). (4) Conclusions: The AI-enhanced algorithm may be a powerful tool to assist clinicians in the early detection of acute pericarditis and differentiate it from STEMI using 12-lead ECGs.

Correlation between ST-elevation myocardial infarction, non-ST-elevation myocardial infarction and the local Earth’s magnetic field changes

Stronger oscillations in the local Earth magnetic field may have an impact on the course of ischemic heart disease. This effect is individual for every person and depends on the sex, age, living territory, season, capability to adjust to magnetic field fluctuations and health status. Individuals who already have cardiovascular disease are more sensitive to magnetic field fluctuations, therefore further research is needed to make conclusions. Aim: To identify correlations between changes in local Earth magnetic field frequencies and patients with ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI) cases per week, cases by sex per week and patients’ blood laboratory parameters (low-density lipoprotein cholesterol and Troponin I level). Methods: A retrospective study of 1667 patients, who were admitted to the Hospital of Lithuanian University of Health Sciences Kaunas Clinics between 1st January and 31st December 2019 due to acute coronary syndrome (STEMI and NSTEMI), were included in the study. Local Earth's time varying magnetic field (TVMF) was measured by a magnetometer located in Baisogala, Lithuania. Data from the magnetometer was collected daily, and weekly averaged. We assessed the correlations between average weekly geomagnetic field strength in six different frequency ranges (Hz) and average number of STEMI and NSTEMI cases per week, cases by sex per week and patients’ blood laboratory parameters (low-density lipoprotein cholesterol and Troponin I level). Results: The presence of a stronger magnetic field in the frequency range of 32-65 Hz was significantly related to the number of cases in the STEMI group during the winter season (r= 0.583, p= 0.036). Tendency towards a positive correlation was found during the winter in the men's group with STEMI in the high frequency range of 32-65 Hz. Low-density lipoprotein cholesterol level correlated positively in the winter STEMI group with the magnetic field in the 32-65 Hz range, and in the autumn STEMI group with the magnetic field in the frequency range of 0-7 Hz. Conclusion: Increased geomagnetic field strength in the high frequency range of 32-65 Hz is associated with a higher number of cases in the STEMI group.

Impact of intracoronary reteplase during primary percutaneous coronary intervention on infarct size in large anterior myocardial infarction: rationale and design of the RECOVER II trial

Thrombus embolization and microvascular obstruction during percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) is commonly detected, which causes inadequate myocardial perfusion and elevated infarct size. An approach with low-dose intracoronary fibrinolytic treatment for reducing distal embolization and improving myocardial reperfusion in high-risk STEMI cases remains controversial. The RECOVER II study represents a multicenter, randomized, double-blind, parallel-group trial assessing low-dose adjunctive intracoronary reteplase during primary PCI in individuals with large anterior myocardial infarction and thrombus determined by angiography. The trial will enroll 306 cases who present within 12 h following STEMI for proximal or mid left anterior descending artery occlusion undergoing primary PCI. Cases will be randomized to receive a bolus intracoronary reteplase at 9 mg or 18 mg vs. placebo. The drug will be delivered over 2 minutes proximal to culprit lesions with an intracoronary catheter early after wire-crossing and before thrombus aspiration or balloon dilation. The primary outcome will be infarct size assessed by late gadolinium-enhanced magnetic resonance imaging (MRI) (% of left ventricular mass) on day 7 after enrollment. Secondary outcomes will include the amount of microvascular obstruction and myocardial salvage index examined via MRI on day 7, angiographic measures of reperfusion [Thrombolysis in Myocardial Infarction (TIMI) coronary flow grade, TIMI frames count and myocardial blush grade], incidence of complete ST-segment resolution at 2 hours after reperfusion, area under the curve for troponin T, and rates of major adverse cardiovascular events at 30 days. RECOVER II will determine whether the addition of low-dose intracoronary reteplase early after wire-crossing as an adjunct to reperfusion treatment reduces infarct size in individuals with large anterior myocardial infarction. ClinicalTrials.gov Identifier: NCT04571580.

Prehospital identification of ST-segment elevation myocardial infarction and mortality (ANZACS-QI 61)

BackgroundEarly recognition of ST-segment elevation myocardial infarction (STEMI) is needed for timely cardiac monitoring and reperfusion therapy.MethodsThree anonymously linked New Zealand national datasets (July 2016–November 2018) were used to assess...

Epidemiological Aspect of ST-Segment Elevation Myocardial Infarction (STEMI) in Saint-Louis of Senegal

Background: Cardiovascular Disease (CVD) has become the largest and most common cause of Non-Communicable Diseases (NCD) related deaths worldwide, accounting for more than 50%. In Senegal, a few studies done on the topic showed a low prevalence of acute coronary syndrome in hospital settings. In the city of Saint-Louis in Northern Senegal, there is little epidemiological data on Acute Coronary Syndrome (ACS) and no study specifically concerned with ST-segment Elevation Myocardial Infarction (STEMI) has been carried out to date. With this in mind, we conducted a study that focused on the analysis of STEMI patients hospitalized in the Cardiology Department of the Regional Hospital of Saint-Louis. The aim of our study was to collect and analyze the epidemiological aspect of STEMI. Results: There were 39 cases of STEMI, (i.e. 82.29% of ACS), giving a hospital prevalence of 8.21%. There was a slight male predominance with a male to female ratio of 1.05. The average age of our patients was 62.93 years ranging from 38 to 90 years. The average time between the onset of pain and arrival at the hospital was 50 hours, ranging from 1 hour to 720 hours. Patients received within the first 12 hours made up 66% (n = 26) of our population, among them, 80.76% (n = 21) (i.e. 53.84% of STEMIs) were able to benefit from thrombolysis. All thrombolysis was performed with Streptokinase. The mean time to thrombolysis was 6 hours ranging from 1 hour and 45 minutes to 11 hours. Arterial hypertension was the most frequent cardiovascular risk factor in our popular with a 43.6% prevalence, followed by diabetes (33.33%), then active smoking (23%). Chest pain was the most frequent symptom, reported in 34 patients (87.17%). The lesions on the Electrocardiogram (EKG) were located in the anterior territory in 64% of the cases (n = 25), in the inferior territory in 28% of the cases (n = 11), in the circumferential territory in 5% of the cases (n = 2), and lateral territory in 5% of the cases (n = 2). Twenty-five patients had a transthoracic echocardiogram, the left ventricular ejection fraction was preserved in 36% of the patients, 40% had moderate ventricular dysfunction and 24% had severe dysfunction. Segmental kinetic disorders of the left ventricle were noted in 18 patients (72%), akinesia in 7 patients (28%) and dyskinesia in 4 patients (16%). The average length of hospitalization was 8.43 days. Seven deaths (17.9%) were recorded during the study. Coronary angiography was performed in six patients (15.38%), and was abnormal in five cases. Conclusion: ST-segment Elevation Myocardial Infarctions remain a major public health issue in Senegal due to their increasing prevalence and poor prognosis due to delayed diagnosis and management.

Myocardial revascularization in Russian Federation for acute coronary syndrome in 2016-2020.

Aim To analyze the number of cases of acute coronary syndrome (ACS) [ST segment elevation myocardial infarction (STEMI), non-ST elevation acute coronary syndrome (nSTEACS)] and results of myocardial revascularization for ACS as a part of the monitoring performed by the Ministry of Health Care of Russia*. This analysis allows, on one hand, providing control of morbidity and mortality of patients with socially significant pathologies and, on the other hand, monitoring the effectivity of treatments to identify and correct their shortcomings. Time-related changes in results of myocardial revascularization performed for ACS patients in the Russian Federation in 2020 were analyzed and compared with the values of 2016-2019 based on data of the Russian Ministry of Health Care monitoring.Material and methods Yearly absolute, relative, and calculated indices of revascularization for ACS were analyzed and compared based on data of the Russian Ministry of Health Care monitoring in 2016-2020.Results In the Russian Federation in 2020, the lowest number of hospitalizations for ACS (403, 931) was recorded with an unprecedented ratio of 1 / 1.8 for STEMI/nSTEACS, respectively. In Russia in 2020, the proportion of primary percutaneous coronary interventions (pPCI) for STEMI continued growing; it reached 44% and peaked to the maximum for 2016-2020. At the same time, the thrombolytic therapy (TLT) remained essential in the structure of reperfusion strategies during those years (24.0-27.3 % of all STEMI cases). Total death rate of admitted patients with STEMI in Russia was stable at the level of 13.1-14.6 %. In 2020, there were no significant differences in quality indexes of the treatment for STEMI from the previous period (2016-2019). A yearly relative increase in the number of PCIs for STEACS (from 16 % in 2016 to 30 % in 2020 and from 30% to 46% for high-risk nSTEACS) was observed. In 2020, a significant increase in death rate was observed for nSTEACS as a whole (to 4.1 %) and for individual subgroups (high-risk nSTEACS, to 4.5 %; after PCI for nSTEACS, to 1.8 %; and after PCI for high-risk nSTEACS, to 2.8 %) whereas mean death rate values in these subgroups in 2016-2019 were 2.75 %, 3.45 %, 1.5 %, and 2.3 %, respectively.Conclusion The analysis of revascularization indexes in ACS patients based on the Ministry of Health Care of Russia monitoring performed in 2016-2020 showed a number of positive trends, including an increase in the total number of revascularization procedures; a decrease in the time from the disease onset to the endovascular treatment; an increase in the availability of stenting for severe ACS; and general stabilization of the mortality. On the other hand, the Russian Federation is considerably behind European countries in several qualitative and quantitative parameters of health care in ACS, such as pPCI availability, symptom-to-balloon time, total mortality of all hospitalized STEMI patients, and revascularization for nSTEACS. Despite the gradual improvement of relative quantitative indexes of myocardial revascularization for ACS, negative changes in the absolute number of myocardial revascularizations for various forms of ACS and a notable increase in the death rate in nSTEACS were observed in 2020, including patients after PCI. There is no doubt that the negative results of myocardial revascularization in Russia in 2020 were due to the effect of the COVID-19 pandemic.* monitoring of measures to reduce the mortality from ischemic heart disease (letters of the Ministry of Health Care of the Russian Federation of 13.03.2015 # 17-6 /10 / 1-177 and of 24.07.2015 # 17-9 / 10 / 2-4128), which includes monthly collection of data on the Federal Research Institute for Health Organization and Informatics portal, the Automated System for Monitoring of Medical Statistics, at http://asmms.mednet.ru.

Clinical Characteristics, Management, and Outcomes of the Patients With ST-Segment Elevation Myocardial Infarction Before and During the COVID-19 Pandemic.

BackgroundThe first case of coronavirus disease 2019 (COVID-19) in the United Arab Emirates (UAE) was reported on January 29, 2020. Various anecdotal reports suggest that fewer patients with ST-segment elevation myocardial infarction (STEMI) have been presented to the hospital during the COVID-19 pandemic. In this study, we examined the patient characteristics, in-hospital management, and outcomes of the patients with STEMI before and during the COVID-19 pandemic in Abu Dhabi, UAE.MethodsWe analyzed the data retrospectively from January 1, 2019 to December 31, 2020 and stratified the same into two periods: before the pandemic (January 1, 2019 to January 28, 2020) and during the pandemic (January 29, 2020 to December 31, 2020). The patient-level data for the two periods were compared to identify the differences in the patient characteristics, in-hospital management, and 30-day mortality outcomes of the patients with STEMI.ResultsDuring the COVID-19 pandemic, the number of STEMI cases was lower (n = 234) than before the pandemic (n = 266), and 11patients (4.7%) tested positive for COVID-19 during their hospital encounter. In comparison to before the pandemic, patients with STEMI were significantly younger (mean age: 50.39 years, standard deviation (SD) ± 10.32 years), less likely to present to the emergency department (ED), and more likely to have histories of hypercholesterolemia (P < 0.001) and coronary artery disease (P < 0.001). Significantly shorter door-to-balloon time (56.6 ± 27.26 min, P < 0.001) and decreased length of stay (4.7 ± 6.8 days, P < 0.001) were observed during the pandemic. However, no considerable difference in the 30-day mortality was observed in 2020 as compared to before the pandemic (2.1% versus 3.0%, respectively).ConclusionsHospital presentation for the patients with STEMI decreased during the COVID-19 pandemic, with significant differences in the door-to-balloon time and length of hospital stay. This indicates that the hospital systems of care continued to operate with higher efficiency during the COVID-19 pandemic than before the pandemic in the UAE.