ST-segment Elevation Research Articles

ST-segment elevation in anterior leads secondary to electric shock – a diagnostic dilemma

ST-segment elevation in anterior leads secondary to electric shock – a diagnostic dilemma

Intracoronary thrombolysis combined with drug balloon angioplasty in a young ST-segment elevation myocardial infarction patient: A case report

BACKGROUND The combination of acute ST-segment elevation myocardial infarction (STEMI) and gastric ulcers poses a challenge to primary percutaneous coronary intervention (PPCI), particularly for young patients. The role of drug-coated balloons (DCBs) in the treatment of de novo coronary artery lesions in large vessels remains unclear, especially for patients with STEMI. Our strategy is to implement drug balloon angioplasty following the intracoronary administration of low-dose prourokinase and adequate pre-expansion. CASE SUMMARY A 54-year-old male patient presented to the emergency department due to chest pain on June 24, 2019. Within the first 3 minutes of the initial assessment in the emergency room, the electrocardiogram (ECG) showed significant changes. There was atrial fibrillation with ST-segment elevation. Subsequently, atrial fibrillation terminated spontaneously and reverted to sinus rhythm. Soon after, the patient experienced syncope. The ECG revealed torsades de pointes ventricular tachycardia. A few seconds later, it returned to sinus rhythm. High-sensitivity tropon in I was normal. The diagnosis was acute STEMI. Emergency coronary angiography revealed subtotal occlusion with thrombus formation in the proximal segment of the left anterior descending artery. Considering the patient's age and history of peptic ulcer disease, after the intracoronary injection of prourokinase, percutaneous transluminal coronary angioplasty and cutting balloon angioplasty were conducted for thorough preconditioning, and paclitaxel drug-eluting balloon angioplasty was performed without any stents, achieving favorable outcomes. CONCLUSION A PPCI without stents may be a viable treatment strategy for select patients with STEMI, and further research is warranted.

Comprehensive strain assessment and mortality after acute myocardial infarction: a retrospective observational study based on the Essen Coronary Artery Disease registry

Background and aimsCurrent ESC guidelines on the management of patients after acute myocardial infarction only include the evaluation of left ventricular (LV) function by assessment of the ejection fraction in...

Incidence and predictors of acute coronary syndrome after transcatheter mitral valve repair

ABSTRACT Background Acute coronary syndrome (ACS) post-transcatheter mitral valve repair (TMVR) carries high mortality. We aim to study the incidence and predictors of ACS in patients who underwent TMVR. Research design and methods We queried the U.S. National Readmission Database to identify all cases of TMVR from 2016 to 2019. We further evaluated the incidence of ACS and used multivariable logistic regression to determine independent predictors of ACS in this population. Results Among 3,742 patients who underwent TMVR, 264 (7.05%) developed ACS. Among ACS patients, 204 (77%) had non-ST-segment elevation ACS and 66 (25%) had ST-segment elevation ACS. Independent predictors of ACS were acute limb ischemia, cardiogenic shock, history of coronary artery disease (CAD), smoking, cardiac arrest, respiratory failure requiring mechanical ventilation, and acute kidney injury. In-hospital mortality among ACS was three times higher in ACS patients than without ACS (16.76% vs. 5.45%, p-value < 0.01). Conclusions ACS is not an uncommon complication after TMVR. The occurrence of ACS after TMVR is associated with high in-hospital mortality, longer length of stay, and higher hospital charges. The strongest predictors of ACS in these patients are the development of acute limb ischemia, cardiogenic shock, and a history of CAD.

Brugada syndrome precipitated by uncomplicated malaria treated with dihydroartemisinin piperaquine: a case report

BackgroundCardiovascular events following anti-malarial treatment are reported infrequently; only a few studies have reported adverse outcomes. This case presentation emphasizes cardiological assessment of Brugada syndrome, presenting as life-threatening arrhythmia during anti-malarial treatment. Without screening and untreated, this disease may lead to sudden cardiac death.Case presentationThis is a case of 23-year-old male who initially presented with palpitations followed by syncope and shortness of breath with a history of malaria. He had switched treatment from quinine to dihydroartemisinin-piperaquine (DHP). Further investigations revealed the ST elevation electrocardiogram pattern typical of Brugada syndrome, confirmed with flecainide challenge test. Subsequently, anti-malarial treatment was stopped and an Implantable Cardioverter Defibrillator (ICD) was inserted.ConclusionsAnother possible cause of arrhythmic events happened following anti-malarial consumption. This case highlights the possibility of proarrhytmogenic mechanism of malaria infection and anti-malarial drug resulting in typical manifestations of Brugada syndrome.

Dynamics of hemostasis system parameters in assessing the risk of complications in the patients with acute myocardial infarction receiving antiplatelet therapy

Background. Current treatment of patients with myocardial infarction is based on the strategy of early invasive coronary intervention in combination with dual antiplatelet therapy - with acetylsalicylic acid and a P2Y12 blocker of platelet adenosine diphosphate receptors. In patients with thrombosis of the infarct-related artery, the phenomenon of “slow/ no reflow” (slowing of blood flow due to distal embolization of the artery), inhibitors of glycoprotein IIb/IIIa platelet receptors are administered as additional disaggregant therapy. In patients undergoing standard antiplatelet therapy in combination with glycoprotein IIb/IIIa inhibitors, there is a risk of hemorrhagic complications, therefore, monitoring of hemostasis parameters is necessary. Currently, there are no standard approaches to monitor the antiplatelet therapy.Objective. To study the dynamics of hemostatic system parameters in patients with acute myocardial infarction during antiplatelet therapy.Material and methods. We assessed platelet aggregation with 10 µmol of adenosine phosphate as an inducer in patients with ST-segment elevation myocardial infarction with different options of standard antiplatelet therapy in combination with GPIIb/IIIa inhibitors. Group 1 included 20 patients on dual antiplatelet therapy (clopidogrel 75 mg + acetylsalicylic acid 100 mg) + GPIIb/IIIa inhibitor (tirofiban). Group 2 included 15 patients on dual antiplatelet therapy (ticagrelor 180 mg + acetylsalicylic acid 100 mg) + GPIIb/IIIa inhibitor.Results. While on antiplatelet therapy the patients in both groups 1 and 2 demonstrated a decrease in platelet aggregation ability under the impact of adenosine phosphate, relative to the norm: 38 (21;43) % and 14 (11;15) %, respectively, the norm being 79 (73;84) % (p&lt;0.05). Meantime, no thrombotic events in the form of stent thrombosis were noted, which indicated antiplatelet therapy efficacy. In an intragroup comparison, the decrease in the platelet aggregation ability was most pronounced in group 2 (p&lt;0.05). By the 7th day of myocardial infarction, the platelet aggregation had continued to decrease to 26 (17;43) % in group 1, to 10 (7;11) % in group 2. The most pronounced effect of antiplatelet therapy was observed in group 2 (p&lt;0.05), which was manifested by a statistically significant decrease in platelet aggregation ability under the impact of 10 µmol of adenosine phosphate.Conclusions. While studying the hemostasis system changes over time in patients with myocardial infarction receiving antiplatelet therapy, we have found that making the platelet aggregation ability assessment with 10 µmol of adenosine phosphate as an inducer is possible to identify the effect of medications. However, further studies including larger patient groups are needed to determine the target values of platelet aggregation with 10 µmol of adenosine phosphate and assess the therapy efficacy.

Cardiac ultrasomics for acute myocardial infarction risk stratification and prediction of all-cause mortality: a feasibility study

BackgroundCurrent risk stratification tools for acute myocardial infarction (AMI) have limitations, particularly in predicting mortality. This study utilizes cardiac ultrasound radiomics (i.e., ultrasomics) to risk stratify AMI patients when predicting all-cause mortality.ResultsThe study included 197 patients: (a) retrospective internal cohort (n = 155) of non-ST-elevation myocardial infarction (n = 63) and ST-elevation myocardial infarction (n = 92) patients, and (b) external cohort from the multicenter Door-To-Unload in ST-segment–elevation myocardial infarction [DTU-STEMI] Pilot Trial (n = 42). Echocardiography images of apical 2, 3, and 4-chamber were processed through an automated deep-learning pipeline to extract ultrasomic features. Unsupervised machine learning (topological data analysis) generated AMI clusters followed by a supervised classifier to generate individual predicted probabilities. Validation included assessing the incremental value of predicted probabilities over the Global Registry of Acute Coronary Events (GRACE) risk score 2.0 to predict 1-year all-cause mortality in the internal cohort and infarct size in the external cohort. Three phenogroups were identified: Cluster A (high-risk), Cluster B (intermediate-risk), and Cluster C (low-risk). Cluster A patients had decreased LV ejection fraction (P < 0.01) and global longitudinal strain (P = 0.03) and increased mortality at 1-year (log rank P = 0.05). Ultrasomics features alone (C-Index: 0.74 vs. 0.70, P = 0.04) and combined with global longitudinal strain (C-Index: 0.81 vs. 0.70, P < 0.01) increased prediction of mortality beyond the GRACE 2.0 score. In the DTU-STEMI clinical trial, Cluster A was associated with larger infarct size (> 10% LV mass, P < 0.01), compared to remaining clusters.ConclusionsUltrasomics-based phenogroup clustering, augmented by TDA and supervised machine learning, provides a novel approach for AMI risk stratification.

Comparison of In-Hospital Outcomes of Anterior Wall Versus Inferior Wall ST Elevation Myocardial Infarction Following Percutaneous Coronary Intervention: A Descriptive Cross-Sectional Study

Comparison of In-Hospital Outcomes of Anterior Wall Versus Inferior Wall ST Elevation Myocardial Infarction Following Percutaneous Coronary Intervention: A Descriptive Cross-Sectional Study

A new electrocardiographic parameter terminal D1S + D3R predicts right ventricular dilatation in acute pulmonary embolism

Objective Right ventricular (RV) overload findings affect the risk classification and treatment approach in acute pulmonary embolism (APE). Recently, it was reported that a new electrocardiography (ECG) parameter, terminal D1S + D3R (T-D1S + D3R) pattern, supported the diagnosis of APE. We aim to search the relationship between T-D1S + D3R pattern and right ventricular dilatation (RVD) in APE. Methods This single-centre, retrospective study was designed with patients aged > 18 years. We screened 267 patients who underwent transthoracic echocardiography (TTE) because of confirmed APE in our emergency department. This study included 72 patients with RVD and 139 patients without RVD [male 41.7%, median age 73,0 (20.8) years; 49.6% male, median age 64,0 (24.0) years]. We compared T-D1S + D3R between RVD (+) and RVD (-) groups. Results We determined that RVD (+) group had more patients with the T-D1S + D3R parameter than RVD (-) group [51 (70.8%) vs. 25 (18.0%), p < 0.001]. In the univariate logistic regression analyses S1Q3T3, (in)complete right bundle branch block (RBBB), T-D1S + D3R, D3-V1 T wave inversion (TWI), V1-3/4 TWI, V1-3/4 ST-segment elevation, and frontal QRS-T [f(QRS-T)] angle predicted RVD, while T-D1S + D3R, V1-3/4 ST-segment elevation, and f(QRS-T) angle remained independent predictors of RVD in patients with APE. Conclusions T-D1S + D3R, a new ECG parameter, was an independent predictor of RVD in patients with APE.

Soluble suppression of tumorigenicity 2 associated with contrast-induced acute kidney injury in patients with STEMI.

Contrast-induced acute kidney injury (CI-AKI) is a common complication after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). Soluble suppression of tumorigenicity 2 (sST2) is associated with AKI. However, the relationship between sST2 and CI-AKI is unclear. This study aimed to investigate the relationship between sST2 and CI-AKI in patients with STEMI. This was a single-center retrospective observational study. Patients diagnosed with STEMI in the Yichun People's Hospital from February 2020 to May 2024 were continuously included. CI-AKI was defined as an increase in serum creatinine of at least 50% or 0.3mg/dL from baseline within 48-72h after contrast exposure. The incidence of CI-AKI after PCI was 12.4% (98/791). Univariate analysis showed that age, fasting plasma glucose, diabetes mellitus, Killip class, left ventricular ejection fraction, estimated glomerular filtration rate, high sensitivity troponin T, N-terminal pro-B-type natriuretic peptide, and sST2 were associated with CI-AKI. The above factors were included in a multivariate analysis, which showed that sST2 was an independent factor for CI-AKI after PCI. The restricted cubic splines showed a nonlinear dose-response relationship between sST2 and CI-AKI (P < 0.001). The integration of the sST2 could significantly improve the ability of the model to identify CI-AKI (NRI 0.681, 95% CI 0.474-0.887; IDI 0.063, 95% CI 0.038-0.099). Elevated sST2 is an independent risk factor for CI-AKI after PCI in patients with STEMI. Integration of sST2 can significantly improve the risk model for CI-AKI.

Comparative Study Between the Effects of High Doses of Rosuvastatin and Atorvastatin on Ventricular Remodeling in Patients with ST-Segment Elevation Myocardial Infarction.

Most studies reported that treating ST-Elevation Myocardial Infarction (STEMI) patients with high doses of rosuvastatin or atorvastatin could improve left ventricular remodeling and cardiac function. The current study compared the impact of high doses of rosuvastatin and atorvastatin on hypertrophy, fibrosis markers, serum inflammatory markers, and left ventricular function in STEMI patients after primary percutaneous coronary intervention (PCI). After primary PCI, eighty STEMI patients were randomized to receive either 20 mg of rosuvastatin (n = 40) or 40 mg of atorvastatin (n = 40) once daily for 3 months. Soluble Suppression of Tumorigenicity-2 (sST2), Matrix Metalloproteinase-9 (MMP9), C-Reactive Protein (CRP), lipid parameters, liver enzymes, and echocardiographic parameters were assessed for the two groups at baseline and after 3 months. After 3 months of treatment, a statistically significant reduction was observed in the rosuvastatin group regarding the levels of CRP (16 ± 6 vs. 20 ± 10 mg/L, P = 0.024) and MMP9 (104 ± 33 vs. 130 ± 42 ng/L, P = 0.003) compared with the atorvastatin group. The median percentage decrease in sST2 level in the rosuvastatin group was higher (6.1%) than in the atorvastatin group (2.3%) after 3 months of treatment. Also, in the rosuvastatin group, LVEF was significantly increased (48.5 ± 9 vs. 43.5 ± 11%, P = 0.029), while LVEDV and LVESV were significantly decreased compared to those of the atorvastatin group (101 [81/135] vs. 134 [100/150] ml, P = 0.041) (53 [37/75] vs. 73 [52/92] ml, P = 0.033), respectively. High-intensity rosuvastatin was superior to high-intensity atorvastatin in reducing the inflammatory response and myocardial fibrosis, thus improving ventricular remodeling and cardiac function better in STEMI patients. This randomized controlled trial was registered on October 11, 2022, on ClinicalTrials.gov under registration number: NCT05895123 "retrospectively registered".

Association between peak troponin level and prognosis among patients admitted to intensive cardiovascular care unit

IntroductionHigh-sensitivity cardiac troponin (hs-cTn) is a key biomarker for myocardial injury, yet its prognostic value in intensive cardiovascular care units (ICCU) remains poorly understood. We aimed to assess the association between peak hs-cTn levels and prognosis in ICCU patients. MethodsAll patients admitted to a tertiary care center ICCU between July 2019 – July 2023 were prospectively enrolled. Patients were divided into five groups according to their peak hs-cTnI levels: A) hs-cTnI <100 ng/L; B) hs-cTnI of 100–1000 ng/L; C) hs-cTnI of 1000–10,000 ng/L; D) hs-cTnI of 10,000–100,000 ng/L and E) hs-cTnI ≥100,000 ng/L. The primary outcome was all-cause mortality at one year. ResultsA total of 4149 patients (1273 females [30.7 %]) with a median age of 69 (IQR 58–79) were included. Group E was highly specific for myocardial infarction (97.4 %) and especially for ST segment elevation myocardial infarction (STEMI) (87.5 %). Patients in group E were 56 % more likely to die at 1-year in an adjusted Cox model (95 % CI 1.09–2.23, p = 0.014) as compared with group A. Subgroup analyses revealed that among STEMI patients, higher peak hs-cTnI levels were not associated with higher mortality rate (HR 1.04, 95 % CI 0.4–2.72, p = 0.9), in contrast to patients with NSTEMI (HR 7.62, 95 % CI 1.97–29.6, p = 0.003). ConclusionsPeak hs-cTnI levels ≥100,000 ng/L were linked to higher one-year mortality, largely indicative of large myocardial infarctions. Notably, the association between elevated hs-cTnI levels and mortality differed between STEMI and NSTEMI patients, warranting further investigation.

Evaluation of Left Ventricular Remodeling and Prognosis after PCI in Acute Myocardial Infarction Using Real-Time, Three-Dimensional Echocardiography Combined with Layer-Specific Strain Imaging

Aim: This study aimed to evaluate left atrial and left ventricular volumes, strains, and strain rates in patients with acute ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI) using real-time three-dimensional echocardiography and layer-specific strain techniques. The relationships between these parameters and left ventricular remodeling (LVR) and prognosis were also explored. Methods: The study included 217 patients with first-episode STEMI who underwent emergency PCI. Echocardiography and myocardial strain analyses were performed within 24 h post-PCI. Patients were categorized into early and non-early LVR groups based on the increase in left ventricular end-diastolic volume (LVEDV). The occurrence of major cardiovascular adverse events (MACE) was followed up for one-year post-PCI. Differences in clinical data and ultrasound parameters between the groups were compared, and the predictive value of myocardial strain indicators for late LVR was analyzed using a multivariate logistic regression model and receiver operating characteristic (ROC) curves. Results: Early LVR occurred in 54.8% of patients and was characterized by decreased left ventricular systolic function, more segments with abnormal movement, and reduced absolute strain values in the three layers of the left ventricular wall myocardium, with a compensatory increase in left atrial strain rate during the contraction phase. The early LVR group showed a higher incidence of MACE at the one-year follow-up. At 6 months post-PCI, 29.9% of patients developed late LVR, which was not completely related to early LVR. Late LVR was associated with a higher incidence of MACE. The longitudinal strain value of each layer of left ventricular myocardium obtained from layer-specific strain imaging showed predictive value for advanced LVR. Conclusions: More than half of patients with STEMI develop early LVR post-PCI, with a higher incidence of MACE during one-year of follow-up, necessitating attention to early LVR in clinical practice. Late LVR, which develops in some patients after 6 months, is also linked to a higher incidence of MACE. Accurate monitoring of the myocardial deformation function using layer-specific strain imaging is expected to become a reference indicator for clinical diagnosis and treatment. Monitoring the structure and function of the left atrium and mitral valve alongside the LVR is important for prognostic assessment and for formulating diagnostic and treatment plans.

ST-segment elevation myocardial infarction with refractory cardiogenic shock due to coronary spasm, a case report

Abstract Background Acute coronary syndrome (ACS) is primarily due to obstructive coronary artery disease (CAD). Nevertheless, in 1-14% of cases, ACS is present without evidence of obstructive CAD. Coronary artery spasm is an uncommon cause of ACS. Diagnostic work-up includes acute invasive coronary angiography and afterwards provocation testing. It is unclear what the optimal patient management is for patients presenting with cardiogenic shock due to ACS caused by coronary artery spasm is unclear. Case summary A 67 year old Caucasian, who underwent elective revision of hip arthroplasty, presented with ST elevations with circulatory collapse, leading to resuscitation due to anaesthesia induction. ECMO-implantation resulted in ROSC. Coronary angiography revealed coronary vasospasm, which was successfully treated with nitrates i.c. successfully. Later, despite of implanted ECMO, recurring hemodynamic deterioration required continuousl administration of nitrates i.v., which finally resulted in the stabilization of circulatory system. ECMO removal was possible 48 hours after implantation and another 12 hours later we extubated the patient. Further we administered calcium antagonists and an ICD was implanted. Finally the patient was discharged 12 days after admission with no physical or neurological restrictions after resuscitation. Discussion This unique case highlights that rare causes of severe ACS with cardiogenic shock need to be considered. Administration of vasodilators, which are not part of the standard care in cardiogenic shock, represent the adequate treatment of a patient with spasm of coronary arteries. Furthermore, the recurrence of acute coronary events must be prevented by drug and device therapy in these patients.

Killip and Kimball classification in the Ultrasound era: Is it time to redefine?

Lung ultrasound is a tool that is increasingly gaining strength in the initial evaluation of the patient in the emergency department and in critical care areas, making it particularly useful for cardiologists. In patients with ST elevation and acute myocardial infarction it has been observed that 25-45% of patients are wrongly classified as Class I in the Killip and Kimball classification after lung ultrasound (subclinical congestion). The clinical relevance of this finding lies in the fact that the greater the number of B lines, the greater short- and long-term the mortality is. An important advantage is that no prolonged time for learning the technique is required. More studies are needed to evaluate the role and importance of subclinical congestion in patients with acute myocardial infarction. Unfortunately, ultrasound is not widely available in developing countries, so the physical examination will continue to play an important role in the initial evaluation of patients with acute myocardial infraction.

Sildenafil-inducing allergic angina in elderly with intertwining sinus arrhythmia, wavy triple sign, wavy double sign (Yasser’s signs), and mild covid-infection; interpretation and management

Rationale: Sildenafil is a phosphodiesterase-5 inhibitor (PDE5-I) drug used to treat erectile dysfunction (ED) and pulmonary arterial hypertension. Allergic angina and infarction are broad-spectrum mast cell activation disorders accompanied by acute coronary syndromes (ACS) and are known as Kounis-Zafras (KZ) syndrome. Sinus arrhythmia is a variation of normal sinus rhythm (NSR) that is associated with an irregular rate in which the change in the R-R interval is greater than 0.12 seconds. Wavy triple and Wavy double ECG signs (Yasser’s sign) are new specific diagnostic and therapeutic signs seen in the cases of hypocalcemia. Mild COVID-19 infection means you have symptoms like cough, sore throat, and fatigue, but no dyspnea. Patient concerns: An elderly married male farmer patient was admitted to the intensive care unit with angina, hypotension, generalized hives, Wavy triple, and Wavy double ECG signs after ingestion of sildenafil tablet with mild COVID-19 infection in a previous chronic obstructive pulmonary disease (COPD). Diagnosis: Sildenafil-inducing Kounis syndrome in the elderly with intertwining sinus arrhythmia, Wavy triple sign, Wavy double sign (Yasser’s signs), and mild COVID-19 infection. Interventions: Electrocardiography, oxygenation, IV fluids, and echocardiography. Outcomes: A dramatic clinical and electrocardiographic improvement had happened. Lessons: Sildenafil-inducing Allergic angina and anaphylaxis may be innovative cardiovascular findings. Mild COVID-19 infection, sometimes, can be insignificant. An associated sinus arrhythmia may be a good cardiovascular sign. The dramatic improvement in both clinical and electrocardiographic ST-segment depressions and elevations supports the efficacy of both anti-ischemic and anti-allergic measures.

Clinical outcomes and coronary artery lesion characteristics of young patients with ST elevation myocardial infarction and no standard modifiable risk factors.

Among ST-elevation myocardial infarction (STEMI) patients, those with no standard modifiable risk factors (SMuRFs: hypertension, diabetes mellitus, hypercholesterolemia, and smoking) have higher 30-day mortality than those with SMuRFs. Differences in coronary lesion characteristics remain unclear. Data from STEMI patients aged ≤60 years from the Asia Pacific Evaluation of Cardiovascular Therapies Network (Australia, Hong Kong, Malaysia, Singapore, and Vietnam) was retrospectively analysed. Exclusion criteria included incomplete SMuRF data, prior myocardial infarction, or prior coronary revascularisation. Lesion type was defined using the American College of Cardiology criteria. Major adverse cardiovascular events (MACE) were defined as peri-procedural myocardial infarction, emergency coronary artery bypass surgery, cerebrovascular event, or mortality. Multiple logistic regressions were used. Of 4404 patients, 767 (17.4%) were SMuRFless. SMuRFless patients were more frequently younger (median age 51 vs. 53 years; p < 0.001), female (22.6% vs. 15.5%; p < 0.001), thrombolysed (20.1% vs. 12.5%; p < 0.001), and in cardiogenic shock (11.2% vs. 8.6%; p = 0.020). SMuRFless patients had significantly higher in-hospital MACE (7.2% vs. 4.3%; adjusted odds ratio [aOR] 2.25; 95% confidence interval [CI] 1.24-4.08; p = 0.008) but 1-year mortality was not significantly different (3.6% vs. 5.7%, aOR 0.58; 95% CI 0.06-6.12; p = 0.549). Compared with patients with SMuRFs (4918 lesions), the SMuRFless (940 lesions) had fewer type B2/C lesions (60.8% vs. 65.6%; p = 0.020) and fewer lesions ≥20 mm (51.1% vs. 57.1%; p = 0.002) but more procedural complications (5.1% vs. 2.7%; p < 0.001). Among young STEMI patients, the SMuRFless have shorter and less complex lesions, but worse procedural and short-term MACE outcomes.

Assessment of Baseline and Post-PCI Electrocardiographic Parameters as Predictors of Left Ventricular Systolic Dysfunction after a First ST-Segment Elevation Myocardial Infarction

Assessment of Baseline and Post-PCI Electrocardiographic Parameters as Predictors of Left Ventricular Systolic Dysfunction after a First ST-Segment Elevation Myocardial Infarction

Ruptured coronary sinus aneurysm in pregnancy combined with cardiogenic shock and elevated V1 and aVR ST segments: Case report.

Sinus of Valsalva aneurysm (SOVA), a rare cardiac malformation, is usually congenital and rarely acquired and most commonly occurring in the right coronary sinus. The clinical presentation of patients with SOVA varies. It is usually asymptomatic when it has not ruptured, and when it compresses neighboring structures or ruptures, it can lead to heart failure or shock, at which point urgent surgical intervention is usually required. Rupture of the sinus of Valsalva aneurysm (RSOVA) during pregnancy is really hard to come by, especially if the clinical presentations resemble that of an acute myocardial infarction. This report describes a pregnant woman with severe chest pain and hypotension with aVR and V1 ST-segment elevation due to RSOVA. Effects of RSOVA on the fetus, disease survival, and prognosis. RSOVA. Open SOVA repair. The patient's blood pressure returned to normal range and clinical symptoms disappeared after the surgery. After 3 months of follow-up, the patient was hemodynamically stable without chest discomfort, and an echocardiogram showed a normal aortic sinus. Progressive aneurysm dilatation or rupture has a poor prognosis. A thorough history and physical examination are fundamental, with echocardiography being the initial diagnostic tool of choice, and other ancillary tests (e.g., computed tomography) being used to complement and confirm the diagnosis. Surgery remains the current treatment of choice for patients with RSOVA, while the continuation of pregnancy in pregnant patients with RSOVA remains a case-by-case measure.

Sex differences in ST-segment elevation acute myocardial infarction

Introduction: Acute ST-segment elevation myocardial infarction constitutes a health problem in the world and in Cuba, with differences according to sex in clinical and laboratory findings, complications and therapeutic response. Objective: to identify sex differences in ST-segment elevation myocardial infarction. Methods: quantitative, cross-sectional, retrospective study of 155 patients, 97 men and 58 women, from the Coronary Intensive Care Unit of the Institute of Cardiology and Cardiovascular Surgery, from January 2020-December 2021. The following variables were explored: general, admission, hospitalization and complications. Results: the following were statistically significant: men developed infarction earlier than women (65±13 vs 71±11.9); of the known coronary risk factors, arterial hypertension predominated (61.3%); smoking prevailed in men (53%) and 54% of the patients with an anterior-extensive topographic location died (80% in men and 100% in women). In addition, there was a predominance of Killip-Kimball IV classification (15.5%), right coronary artery as the responsible vessel (29.9%), heart failure as a complication (26.8%) and death (15.5%) in men. However, in women, the anterior descending coronary artery prevailed as the vessel responsible for the lesion (34.4%). Conclusions: there are differences between men and women in age, risk factors and clinical manifestations of ST-segment elevation myocardial infarction. Women were more likely to present extensive anterior myocardial infarction, a topography that had a greater incidence of mortality as a complication