Onset Of ST-segment Elevation Myocardial Infarction Research Articles

Early Repolarization Pattern Is Associated with Increased Risk of Early Ventricular Arrhythmias during Acute ST Segment Elevation Myocardial Infarction.

Early repolarization (ER) and acute ST segment elevation myocardial infarction (STEMI) are sharing the pathophysiology of J wave syndromes. It is speculated that early ventricular arrhythmias (VAs) during STEMI may be predisposed by ER. Our aim was to study the association between ER pattern and risk of VAs during acute STEMI. The study included 102 male patients with acute STEMI who were divided into two groups: cases and controls. Cases included 52 patients with sustained VAs during the first 48 hours from the onset of STEMI, while controls included 50 patients with no VAs. On 12-lead surface electrocardiogram, ER was defined as ≥ 1 mm elevation of J point in at least two inferior or lateral leads with or without ST segment elevation. Mean age was 48.44 ± 10.08 years and mean left ventricular ejection fraction (LVEF) was 42.25 ± 11.1%. ER pattern was more frequent in cases than controls (29 vs 14 patients, P = 0.008). Notched J wave (P = 0.0007) and horizontal ST segment (P = 0.033) were more frequent in cases than controls. On adjusted regression model, LVEF (OR: 0.95, 95% CI: 0.91-0.99, P = 0.015) and ER (OR: 3.39, 95% CI: 1.41-8.12, P = 0.006) could predict VAs, while QTc interval (P = 0.24) and QTd (P = 0.86) did not have predictive effect. Inferior/inferolateral and global ER pattern (P = 0.044 and 0.031 respectively), notched J wave (P = 0.001), increasing J wave amplitude (P = 0.042), and ST segment elevation (P = 0.001) were associated with a higher risk of VAs. ER is associated with increased risk of VAs in the setting of acute STEMI.

Time of symptom onset and value of myocardial blush and infarct size on prognosis in patients with ST-elevation myocardial infarction

In patients with ST-segment elevation myocardial infarction (STEMI), the time of onset of ischemia has been associated with myocardial infarction (MI) size. Myocardial blush grade (MBG) reflects myocardial response to ischemia/reperfusion injury, which may differ according to time of the day. The aim of our study was to explore the 24-hour variation in MBG and MI size in relation to outcomes in STEMI patients. A retrospective multicenter analysis of 6970 STEMI patients was performed. Time of onset of STEMI was divided into four 6-hour periods. STEMI patients have a significant 24-hour pattern in onset of symptoms, with peak onset around 09:00 hour. Ischemic time was longest and MI size, estimated by peak creatine kinase concentration, was largest in patients with STEMI onset between 00:00 and 06:00 hours. Both MBG and MI size were independently associated with mortality. Time of onset of STEMI was not independently associated with mortality when corrected for baseline and procedural factors. Interestingly, patients presenting with low MBG between 00:00 and 06:00 hours had a better prognosis compared to other groups. In conclusion, patients with symptom onset between 00:00 and 06:00 hours have longer ischemic time and consequently larger MI size. However, this does not translate into a higher mortality in this group. In addition, patients with failed reperfusion presenting in the early morning hours have better prognosis, suggesting a 24-hour pattern in myocardial protection.

Response to Relation Between Time of Symptom Onset of ST‐Segment Elevation Myocardial Infarction and Patient Baseline Characteristics: From the National Cardiovascular Data Registry

We read the article by Mogabgab et al with great interest.1 The authors aimed to investigate the relationship between patient characteristics and outcomes in ST-segment elevation myocardial infarction (STEMI). This study revealed that the circadian rhythm of STEMI with a morning peak continues to exist and represents a potential target for preventative strategies. Additionally, the authors observed that some patient characteristics were consistently varied with time of symptom onset and might reflect underlying physiologic differences that alter the timing of events. The study was successfully planned and the results were presented well; thanks to the authors for their contribution. It has long been known that circadian rhythm plays a pivotal role in many biologic phenomena, including secretion of hormones and activities of the nervous system, and it has also been noted to occur in the incidences of certain cardiovascular events. Circadian variation for the onset of STEMI has been well investigated in many studies, and an early morning peak has been reported frequently. This early morning peak is often described with the changes in autonomic nervous system activity, blood fibrinolytic activity, platelet aggregability, activity of hemostasis, endothelial function, and coronary tone during the daily cycle, especially in the early morning hours.2-5 However, it is a well-known fact that different regions of the world have different circadian variations with regard to cardiovascular diseases. Studies showing the early morning peak of the onset of STEMI are very common and often come from Western populations. Furthermore, other studies that examined the circadian variation of STEMI in different population cohorts found that onset of STEMI happened between midnight and noon in British Caucasians and Indo-Asians,6 between noon and midnight in a Mediterranean Caucasian6 and Bulgarian cohort,7 between midnight and morning in a Chinese cohort,8 and with afternoon predominance in a Turkish population.9 Environmental and genetic background, customs, education, socioeconomic status, sociocultural habits, physical activity level, working hours (night people or morning people), and eating and sleeping habits might be possible underlying causes of ethnic disparities in cardiovascular risk factor profiles in different populations and should be evaluated. With respect to the effect of circadian variation in outcomes of cardiovascular disease, Khan et al10 examined the risk of cardiovascular disease outcomes among South Asian, Chinese, and white patients, and they assumed that South Asian and Chinese patients had a lower risk of death and of developing cardiovascular outcomes compared to whites. In their study, Hulten et al11 aimed to predict all-cause mortality and nonfatal myocardial infarction among Caucasian, African, and East Asian ethnicities, and found that compared to other ethnicities, East Asians had fewer events than expected. Wong et al12 showed that among the 3 ethnic groups (Malay, Chinese, and Indian), Indians had the highest risk of developing premature acute myocardial infarction. Additionally, circadian variation at the time of onset of chest pain in patients with STEMI may be different regarding infarction site in different population cohorts.13, 14 Circadian variation of STEMI might not be equally effective throughout the world. Ethnic disparities may be partly responsible for cardiovascular risk prevalence and outcomes of STEMI. Thus, instead of the term circadian rhythm, it might be more accurate to use the term population rhythm. Further large-scale clinical studies are needed to analyze the underlying pathophysiological mechanisms causing those ethnic disparities in the chronobiology of STEMI. Murat Celik, MD Baris Bugan, MD Emre Yalcinkaya, MD Uygar Cagdas Yuksel, MD Turgay Celik, MD Department of Cardiology, School of Medicine Gulhane Military Medical Academy Ankara, Turkey

Management of the no-reflow phenomenon

Cardiologia CROATICA Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion strategy for treating acute ST-segment elevation myocardial infarction (STEMI). The main goals are to restore epicardial infarct-related artery (IRA) patency and achieve microvascular reperfusion as early as possible, thus limiting the extent of irreversibly injured myocardium. Unfortunately, in many patients myocardial perfusion remains poor despite the successful restoration of IRA patency. The lack of adequate myocardial perfusion of a given coronary segment after prolonged ischemia without angiographic evidence of mechanical vessel obstruction is termed. It is clinically important as it is independently associated with increased occurrence of malignant arrhythmias, heart failure, in-hospital and long-term mortality. After the onset of STEMI an efficient emergency system that reduces ischaemic time is crucial for no-reflow prevention in patients undergoing PPCI. The risk of distal embolization is related to thrombus burden, which may be reduced by the use of glycoprotein IIb/IIIa inhibitors. The most potent endogenous mechanism to limit infarction is ischaemic preconditioning. Among patients undergoing PPCI thrombus aspiration has an emerging role. Other pharmacological agents (calcium channel blockers, sodium nitroprusside, adenosine, nicorandil) show promise for reduction of no reflow but require validation in larger, randomized trials. In conclusion, to improve clinical outcomes of STEMI we need to focus on increasing microvascular flow to ischaemic (but not infarcted) myocardium and reducing ischaemiareperfusion injury. No reflow is a multifactorial process, so it is unlikely that one treatment will prevent or cure the process. Thus, prophylactic vasodilator therapy, mechanical devices, ischaemic preconditioning and potent platelet inhibitors in combination are more likely to be effective than any of these alone.

Relation Between Time of Symptom Onset of ST‐Segment Elevation Myocardial Infarction and Patient Baseline Characteristics: From the National Cardiovascular Data Registry

The presence of a morning excess of ST-segment elevation myocardial infarction (STEMI) has been observed. The relation between patient characteristics and timing of STEMI may provide insight into the biological processes responsible for this phenomenon. Patient baseline characteristics will vary with timing of STEMI. We performed an analysis using a large national registry of unselected patients with STEMI (N=45,218). Patients were categorized by time of symptom onset: early (6 am-2 pm), late day (2 pm-10 pm), and overnight (10 pm-6 am) then evaluated for variations in characteristics. A circadian variation in the timing of symptom onset of STEMI was observed (early 41%, late day 32%, and overnight 26%, P<0.001). Circadian variations in factors known to alter timing of events were seen, including lower rates of home β-blocker use, smoking, and diabetes, with early onset of STEMI symptoms. In addition, patients in the 6 am to 2 pm subgroup were more likely older, white race, and male, with higher rates of home aspirin use and lower rates of obesity. Higher rates of coexisting cardiovascular disease, including prior heart failure, 3-vessel coronary artery disease, and depressed left ventricular ejection fraction, were observed in the overnight group. More robust antiplatelet therapy with home clopidogrel use was not associated with a change in the timing of events. A morning excess of STEMI continues to exist and represents a potential target for preventative strategies. Patient baseline characteristics vary with the onset of STEMI and may reflect a physiologic relationship between these factors and the timing of events.

The Comparison in Reduction of QT Dispersion After Primary Percutaneous Coronary Intervention According to Existence of Thrombectomy in ST‐Segment Elevation Myocardial Infarction

Primary percutaneous coronary intervention (PPCI) is the standard treatment in patients with ST-segment elevation myocardial infarction (STEMI). Thrombectomy devices are used to remove thrombus or to prevent embolization of thrombus and plaque during PPCI. QT dispersion (the difference between maximal and minimal QT interval calculated on a standard 12-lead electrocardiogram) represents the regional nonuniformity of ventricular repolarization. It may reflect early coronary reperfusion in reducing electrophysiological instability by decreasing QT dispersion in the recovery phase after acute STEMI. Our aim was to show whether an additional effect of thrombectomy on reducing QT dispersion will be seen in patients undergoing PPCI for STEMI. The study population included 80 consecutive patients who were admitted to the hospital within 12 hours after the onset of acute STEMI and angiographic evidence of intraluminal thrombus in the infarct-related artery. Patients with atrial fibrillation or flutter, intraventricular conduction abnormalities, pre-excitation, cardiogenic shock, cardiomyopathy, ventricular hypertrophy, and severe valvular heart disease were excluded from the study. There were no significant differences between groups regarding gender, age, cardiovascular risk factors, and time from symptom onset to treatment, except for smoking, which was much higher in the PPCI plus thrombectomy group. Infarct-related artery distribution (left anterior descending artery [LAD] to non-LAD), and neither the rate of balloon predilatation nor stent implantation were different between groups. Successful coronary patency was achieved in each case. QT interval measurements were similar between groups at admission. However, at 24 hours, QT and QTc dispersions were less in the PPCI plus thrombectomy group (41 ± 9 vs 33 ± 7 ms, P < 0.05 and 45 ± 8 vs 35 ± 7 ms, P = 0.03, respectively), but not in the other QT interval measurements. When patients were divided into 2 groups according to infarct-related artery (LAD and non-LAD groups), QT interval measurement parameters did not show any significant differences. Thrombectomy additional to PPCI helps more effective reperfusion at the microvascular level and provides additional prognostic information.

Circadian Variation in Patient Characteristics and Outcomes in ST-Segment Elevation Myocardial Infarction

A morning peak in ST-segment elevation myocardial infarction (STEMI) has been described. The authors explored the relationship between variation of symptom onset, patient characteristics, and outcomes in two worldwide fibrinolytic trials. A total of 35 492 patients with STEMI were grouped into 8-h intervals by time of symptom onset: early (06:00 to 13:59 h), late-day (14:00 to 21:59 h), overnight (22:00 to 05:59 h). The authors correlated timing with patient characteristics and outcomes (adjusted for thrombolysis in myocardial infarction [TIMI] risk score) first in InTIME II-TIMI 17 trial (N = 15 031), and confirmed in the ExTRACT-TIMI 25 trial (N = 20 461). Timing was similar in the derivation (early 49%, late-day 30%, and overnight 21%; p < .001) and validation set (48%, 31%, and 21%, respectively; p < .001). Some patient characteristics consistently varied with time of symptom onset. Patients in the early cohort were older with poorer renal function. The late-day group had more smokers with higher initial heart rate and systolic blood pressure. Those with overnight symptom onset had higher rates of obesity, prior myocardial infarction, and treatment delays. Prior use of aspirin and beta-blockers was also highest in the overnight group. Relative to the early cohort, adjusted mortality was higher with late-day onset (derivation odds ratio [OR]: 1.19, p = .04; validation OR: 1.18, p = .01), but there was no excess in mortality overnight compared with early (derivation OR: .97, p = .72; validation OR: 1.01, p = .90). Composite endpoints followed similar patterns. This study indicates that circadian patterns in onset of STEMI continue to exist with patient characteristics differing by time of day. Despite a potential physiologic resistance to morning thrombolysis, outcomes were best in the early cohort, intermediate overnight, and worst with late-day symptom onset. Efforts to reduce smoking and improve control of blood pressure could reduce the number of patients with late-day onset of STEMI who experience the worst outcomes. (Author correspondence: owen@mogabgab.com)

Association between activity at onset of symptoms and complications of St-segment elevation myocardial infarction in Erbil teaching hospital

Background and objectives: It is controversial whether the onset of myocardial infarction occurs randomly or is precipitated by identifiable stimuli. The aim of this study is to emphasise the relationship of exercise, rest and bed related onset ST-segment elevation myocardial infarction with subsequent in-hospital complications. Methods: The study has been done perspectively having collecting data from those patients whom had been admitted from 1 st of November 2008 till 1 st of June 2009 to the Coronary Care Unit (CCU) in Hawler Teaching Hospital in Erbil city. The study had included one hundred twenty one patients (84 men, 37 women) whom they exhibited a newly developed ST-segment elevation myocardial infarction (STEMI) over the chronological age ranged from (35-86), mean age (56.76±11.12). Transthoracic echocardiography had been employed over 88 recently admitted patients whose in-hospital complications were precisely being clarified and recorded. The onset of pain of acute myocardial infarction whether during exercise, rest or during sleep (bed) has been verified and studied. Results: Patients whose symptoms of STEMI began at rest, or bed had higher incidence of early acute mitral regurgitation (26, 59.1%), (13,65%) respectively versus exercise related STEMI onset(8,33.3%)p value=0.04. Conclusion: Early echocardiographic examination is recommended especially to patients having had physical body rest in order to detect early bed-related onset STEMI and to di

Contents of second peak in the circadian variation of acute myocardial infarction in the Japanese population

Circadian variation has been accepted as a factor in acute myocardial infarction (AMI). An increased incidence of cardiac events in the morning has been reported for a long time. Recent reports have indicated that the onset of AMI shows two peaks, which occur in the morning and evening. It has also been demonstrated that circadian pattern of AMI may vary with sex and age. We investigated 522 consecutive patients who underwent primary percutaneous coronary intervention (PCI) for ST segment elevation myocardial infarction (STEMI) between 2000 and 2010. The patients were classified into 3 age groups: younger (≤59 years old), intermediate (60-79 years old), and older (≥80 years old). Clinical data were investigated, including the age and sex, angiographic characteristics, and time of onset of STEMI. There were two peaks in the onset of STEMI throughout the day, which were at 7:00-10:00 and 19:00-21:00 h, among all patients (male and female). Stratified analysis showed that older females formed the main part of the second peak. There were two peaks in the onset of STEMI in a Japanese population in Tokyo. The second peak was significantly dominated by the older female group. Age and gender influenced the second peak in the circadian variation of AMI in a Japanese population in Tokyo.

CLINICAL RESULTS OF THROMBOLYTIC THERAPY WITH ALTEPLASE AND TENECTEPLASE IN PATIENTS WITH MYOCARDIAL INFARCTION

Aim. To evaluate the clinical results of thrombolytic therapy with thrombolytics (alteplase, tenecteplase) in patients with ST segment elevation myocardial infarction (STEMI). Material and methods. Patients with STEMI (n=181) included in the study were split into two groups depending on the thrombolytic agent: patients treated with alteplase - group 1 (n=78); patients treated with tenecteplase — group 2 (n=52). Patients with STEMI who had no thrombolysis due to late treatment-seeking or the presence of contraindications were included into the group 3 (n=51). Thrombolysis took place both in pre-hospital and in-hospital period. Time before the thrombolysis, STEMI clinical course, mortality , and complications were analyzed. Results. The average time pain-thrombolysis was 2.7±0.22 hours. High efficacy of both thrombolytic drugs was proved in the most of patients. Mortality in patients received thrombolysis was 6.4–7.7%; this in patients without thrombolytic therapy — 24%. Thrombolysis performed in the first 3 hours after STEMI onset reduced mortality to 3.4%. No one intracranial hemorrhage or allergic reaction was registered. Conclusion. Thrombolytic therapy with alteplase and tenecteplase in patients with STEMI in the real clinical practice was high efficient, reduced hospital mortality and induced a few adverse reactions.

Effect of age on discipline of onset timing with acute ST segment elevation myocardial infarction: study in china

ObjectiveTo compare the differences of onset time in old people and middle-youth people with acute ST segment elevation myocardial infarction (STEMI).MethodsFrom January 2000 and May 2010, 1024 patients with STEMI...

Circadian variations of infarct size in acute myocardial infarction

BackgroundThe circadian clock influences a number of cardiovascular (patho)physiological processes including the incidence of acute myocardial infarction. A circadian variation in infarct size has recently been shown in rodents, but...

Circadian variation of acute st segment elevation myocardial infarction by anatomic location in a Turkish cohort

SummaryBackgroundTo evaluate the relationship between site of infarction (anterior vs. inferior) and circadian variation in patients with ST segment elevation myocardial infarction (STEMI) in a Turkish cohort.Material/MethodsThis restrospective study enrolled 465 patients (407 male, mean age 65±7 years) with STEMI. Patients were then categorised into 4 6-hour increments according to the time of day during which the symptoms began (12:00 AM–06:00 AM, 06:00 AM–12:00 PM; 12:00 PM–06:00 PM and 06:00 PM–12:00 AM hours). Characteristics of patients by site of infarction (anterior vs. inferior) were compared.ResultsThe frequency of onset of acute anterior MI as determined by onset of pain demonstrated significant circadian variation among the 4 time periods, demonstrating bimodal peaks (afternoon and morning) and a trough between 06:00 PM to 06:00 AM. The incidence of occurrence of MI between 06:00 AM to 06:00 PM was 4.50 times that of the average frequency of the remaining 12 hours of the day. The frequency of onset of acute inferior MI as determined by onset of pain exhibited significant circadian variation among the 4 time periods, demonstrating bimodal peaks (midnight to 06:00 AM and 06:00 AM to noon) and a trough between noon to midnight. The incidence of occurrence of MI between midnight to noon was 4.25 times that of the average frequency of the remaining 12 hours of the day.ConclusionsDifferent circadian periodicity in the time of onset of STEMI was found regarding infarction site in a Turkish cohort. This may be related to genetic and/or demographic characteristics of the Turkish population.

Prognostic value of cardiac sympathetic nerve activity evaluated by [123I]m-iodobenzylguanidine imaging in patients with ST-segment elevation myocardial infarction

BackgroundMany studies have shown that cardiac sympathetic nerve activity evaluated by [123I]m-iodobenzylguanidine ([123I]MIBG) scintigraphic study during a stable period is useful for determining the prognosis of patients with chronic heart...

EFFECTS OF CARVEDILOL ON PLATELET AGGREGATION IN MEN WITH ST-ELEVATION ACUTE MYOCARDIAL INFARCTION

Aim. To study influence of beta-blockers carvedilol and metoprolol tartrate on platelet aggregative ability, evaluated by three different methods, in patients with acute ST segment elevation myocardial infarction (STEMI). Material and methods. A total of 86 men aged 36-68 with uncomplicated STEMI were included into an open, comparative, randomized study. Patients were randomized into two groups of beta-blocker treatments. Patients (n=44) of the first group received carvedilol; patients (n=42) of the second one - metoprolol tartrate. Parameters of platelet hemostasis: the maximum amplitude and rate of platelet aggregation induced by ADP, ristomycin and collagen; mean platelet volume (MPV); serum level of soluble CD40 ligand (sCD40L) were evaluated on the 2nd and 24th day after STEMI onset. Results. In patients with uncomplicated STEMI carvedilol more prominently reduced in vitro platelet aggregation induced by adenozin-5'-diphosphate in high concentration, ristomycin and collagen than metoprolol tartrate. Сarvedilol also more significantly decreased MPV in comparison with metoprolol tartrate. However, effect of both carvedilol and metoprolol tartrate on the level of another platelet aggregation marker - sCD40L was comparable. Conclusion. Carvedilol and metoprolol tartrate have similar effect on platelet aggregation though in according to some tests carvedilol more prominently reduces platelet aggre???gation than metoprolol tartrate.

Troponin T Concentration 3 Days after Acute ST-Elevation Myocardial Infarction Predicts Infarct Size and Cardiac Function at 3 Months

Objectives: The evaluation of infarct size and left ventricular function after acute myocardial infarction is important for predicting the subsequent clinical course. This assessment can be achieved by non-invasive imaging methods, but biochemical assays are frequently used as an alternative. We investigated the ability of a single measurement of cardiac troponin T (cTnT) the third morning after onset of ST-segment elevation myocardial infarction (STEMI) to predict infarct size and left ventricular ejection fraction (LVEF). Methods: The study population consisted of 103 patients with their first STEMI treated with thrombolysis. Blood samples for determination of cTnT were drawn the third morning after onset of symptoms. Infarct size and LVEF were assessed by magnetic resonance imaging 3 months later. Results: Linear regression analysis showed a strong, significant correlation between third-day cTnT and infarct size at 3 months (r = 0.84, p < 0.0001). A significant but inverse and weaker correlation was obtained between third-day cTnT and LVEF (r = –0.63, p < 0.0001). Adjusting for age, gender, infarct location and medication changed the results marginally. Conclusions: A single cTnT value the third morning after onset of STEMI predicted the final infarct size in this group of patients with their first STEMI, and might be useful for ruling out impaired LVEF.

Clinical Implications of Elevated Serum Interleukin‐6, Soluble CD40 Ligand, Metalloproteinase‐9, and Tissue Inhibitor of Metalloproteinase‐1 in Patients with Acute ST‐segment Elevation Myocardial Infarction

Atherosclerosis is widely accepted as a chronic inflammatory disease. Research paid much attention to sensitive specific serum biomarkers for vulnerable plaques. The markers not only serve as diagnostic tools for the identification of patients with acute coronary syndrome (ACS), but also help us to identify high-risk patients. However, the existing data are limited and have been conflicting. Circulating interleukin-6 (IL-6), soluble CD40 ligand (sCD40L), metalloproteinase-9 (MMP-9), and tissue inhibitor of metalloproteinase-1 (TIMP-1) might correlate with the onset and the cardiac mortality of patients with ST-segment elevation myocardial infarction (STEMI). Serum levels of IL-6, sCD40L, MMP-9, and TIMP-1 were measured by sandwich enzyme-linked immunosorbent assay (ELISA) in 263 patients with STEMI and 262 age- and gender-matched control subjects without coronary artery disease (CAD). The patients with STEMI were then followed prospectively for 24 mo for the occurrence of cardiac mortality. Compared with the control subjects, patients with STEMI exhibited higher levels of IL-6 (p<0.001), sCD40L (p<0.001), MMP-9 (p<0.001), TIMP-1 (p=0.045), and MMP-9/TIMP-1 ratio (p=0.007). Significant and positive correlations between MMP-9 and TIMP-1 (r=0.610, p<or=0.001]), IL-6 and creatine kinase (CK) (r=0.159, p=0.022), and IL-6 and Troponin-I (TnI) (r=0.141, p=0.042) were observed by Spearman's correlations analysis. Logistic regression analysis revealed that IL-6 significantly and independently correlated with the occurrence of STEMI, and IL-6 was an independent predictor for cardiac mortality during a 24-mo follow-up in patients with STEMI. The present study indicates that elevated admission level of IL-6, but not of sCD40L, MMP-9, or TIMP-1, might indicate the onset of STEMI, and could provide prognostic value for future cardiac mortality within 2 y in patients with STEMI.

Clopidogrel in ST-elevation myocardial infarction patients undergoing percutaneous coronary intervention

Clopidogrel has become a mainstay in the management of acute coronary syndrome patients over the past decade, as well as an essential component of percutaneous coronary intervention (PCI) pharmacotherapy. Until recently, no prospective study has evaluated the effectiveness of clopidogrel in the setting of an ST-segment elevation myocardial infarction (STEMI). The majority of patients presenting with STEMI receive thrombolytic therapy (aspirin, heparin and a fibrinolytic agent) although many do not achieve or maintain adequate reperfusion of the infarct-related artery. The CLARITY (Clopidogrel as Adjunctive Reperfusion Therapy) study and the PCI–CLARITY substudy were designed to address whether a beneficial effect of clopidogrel, including a loading dose, would be attained among STEMI patients who were being treated with thrombolytic therapy and undergoing coronary angiography during the index hospitalisation. A total of 3491 patients who presented within 12 h after the onset of STEMI were randomly assigned to receive clopidogrel (300-mg loading dose followed by 75 mg daily) or placebo. Patients were scheduled to undergo coronary angiography after 48 h, and those who underwent PCI during the index hospitalisation formed the basis of PCI–CLARITY. This PCI cohort was followed for the combined end point of cardiovascular death, recurrent myocardial infarction and stroke for 30 days.

Clinical characteristics and management of patients with ST segment elevation myocardial infarction in China: survey of 7510 cases

To analyze the clinical characteristics and management of the patients with ST segment elevation myocardial infarction (STEMI) in China. As part of the international multicentre CREATE Study, the clinical data of 7510 patients with STEMI presenting their symptoms within 12 hours of onset who were hospitalized in 274 centers throughout China from July 2001 through July 2004, aged 62.7, were collected to be analyzed. 99.3% of these patients had STEMI, and 0.7% had new left bundle-branch block. 11.5% of them underwent percutaneous coronary intervention (PCI), 52.5% underwent thrombolytic therapy, and 0.1% coronary artery bypass grafting. All types of reperfusion therapy were carried out to 62.4% of the patients during the hospitalization. The medication therapy used was similar to those in the previous Registry report. The composite of all-cause mortality, re-infarction, and stroke within the first 7 days was 10.3% and the all-cause mortality within 30 days was 11.1%. The clinical characteristics and management of the STEMI patients in China have been described. The age of onset of STEMI is 62 years on average. The most common complication is hypertension, and diabetes mellitus is relatively rare. rt-PA was used rarely mainly because of the expensive price. A large proportion of patients in China receive reperfusion, which is worth recommendation. Active intervention should be carried out in the early stage after infarction.