Wall ST-segment Elevation Myocardial Infarction Research Articles

Zawał ściany przednio-bocznej mięśnia sercowego u chorej po wszczepieniu stentu do gałęzi przedniej zstępującej przed dziesięciu laty, kontrolowanej angiograficznie dwa tygodnie wcześniej

The article refers to a case of a woman who underwent an anterior wall ST-segment elevation myocardial infarction (STEMI) and angioplasty left anterior descending (LAD) 10 years ago. The angiography that she underwent 2 weeks before the next STEMI did not show any relevant atherosclerotic changes. Nonetheless, she was hospitalized 14 days later due to a new ST elevation in a scar after pre-existing myocardial infarction. After a coronarography we identified an occlusion LAD below the stent. In this publication we discuss the problem of the lack of a simple, cheap and unmistakable method that would enable us to identify an unstable sclerotic plaque.

A Very Elderly Woman Experiencing Two Episodes of Acute Myocardial Infarction Treated by Percutaneous Coronary Intervention: A Case Report and Literature Review

Advanced age is associated with poor outcome among patients with acute myocardial infarction (AMI). It appears that elderly patients are treated more conservatively because of multiple comorbidities and higher risk of further invasive therapy. Reperfusion therapy for AMI may improve survival, and previous studies have shown that patients receiving percutaneous coronary intervention (PCI) have better clinical outcomes than those given thrombolytic therapy. We report our experience with a 96-year-old woman with anteroseptal wall ST-segment elevation myocardial infarction successfully treated with primary PCI. One stent was implanted in the left anterior descending artery occlusive lesion. The patient survived and was discharged from the hospital 7 days later. She received optimal medical therapy and had no major adverse cardiac events within 1 year. Unfortunately, the patient had non-ST-segment elevation myocardial infarction 18 months later. We discussed with her family about the risk/benefit ratio of PCI, and they agreed with the procedure. We performed PCI successfully and the patient was discharged 5 days later. No major adverse cardiac events occurred within 4 months. In very elderly patients without multiple comorbidities, PCI is safe for AMI and effective in shortening hospital stay, reducing in-hospital and short-term mortality. We also discuss our strategy for this very elderly patient and the present therapy for AMI in nonagenarians.

Culprit artery in evolving inferior wall acute myocardial infarction: RCA vs LCx: reply

With interest we read the comment by Fiol et al. 1 on our study2 demonstrating a low diagnostic accuracy of the well-established algorithm3 to predict the culprit artery in an all-comer cohort of patients with inferior wall ST-segment elevation myocardial infarction (STEMI). In a previous publication, Fiol et al. showed that ST-segment depression in standard lead I of the 12-lead electrocardiogram (ECG) showed the highest sensitivity (92%) to predict right coronary artery occlusion in inferior STEMI patients.4 The investigators could identify the culprit artery in more than 95% of cases …

Comparison of Usefulness of N-Terminal Pro-Brain Natriuretic Peptide as an Independent Predictor of Cardiac Function Among Admission Cardiac Serum Biomarkers in Patients With Anterior Wall Versus Nonanterior Wall ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

The purpose of the present study was to determine the prognostic value of N-terminal pro-brain natriuretic peptide (NT-pro-BNP), among other serum biomarkers, on cardiac magnetic resonance (CMR) imaging parameters of cardiac function and infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. We measured NT-pro-BNP, cardiac troponin T, creatinine kinase-MB fraction, high-sensitivity C-reactive protein, and creatinine on the patients' arrival at the catheterization laboratory in 206 patients with ST-segment elevation myocardial infarction. The NT-pro-BNP levels were divided into quartiles and correlated with left ventricular function and infarct size measured by CMR imaging at 4 to 6 months. Compared to the lower quartiles, patients with nonanterior wall myocardial infarction in the highest quartile of NT-pro-BNP (> or = 260 pg/ml) more often had a greater left ventricular end-systolic volume (68 vs 39 ml/m(2), p <0.001), a lower left ventricular ejection fraction (42% vs 54%, p <0.001), a larger infarct size (9 vs 4 g/m(2), p = 0.002), and a larger number of transmural segments (11% of segments vs 3% of segments, p <0.001). Multivariate analysis revealed that a NT-pro-BNP level of > or = 260 pg/ml was the strongest independent predictor of left ventricular ejection fraction in patients with nonanterior wall myocardial infarction compared to the other serum biomarkers (beta = -5.8; p = 0.019). In conclusion, in patients with nonanterior wall myocardial infarction undergoing primary percutaneous coronary intervention, an admission NT-pro-BNP level of > or = 260 pg/ml was a strong, independent predictor of left ventricular function assessed by CMR imaging at follow-up. Our findings suggest that NT-pro-BNP, a widely available biomarker, might be helpful in the early risk stratification of patients with nonanterior wall myocardial infarction.

Hyperosmolar hyperglycemic state induced myocardial infarction: a complex conjunction of chronic and acute complications with diabetes mellitus

Diabetes mellitus is associated with acute and chronic complications that cause major morbidity and significant mortality. We report a 69-year-old man with unknown diabetes, presenting vague epigastric discomfort, polyuria, polydipsia, fatigue, anorexia, weight loss over 1 week and severe chest pain for 1 day. Electrocardiogram revealed ST-segment elevation in lead V1 through V6. Blood chemistry examination revealed a creatine kinase level of 2053 U/l, creatine kinase-MB (CK-MB) level 43 U/l, a troponin I level of 23.21 ng/ml, a blood sugar level of 957 mg/dl, blood osmolality of 324 mosm/kg and no ketonemia. The patient was diagnosed as hyperosmolar hyperglycemic state accompanying acute anterior wall ST-segment elevation myocardial infarction on unknown diabetes mellitus. Aggressive therapy failed to ameliorate the patient's clinical outcome.

ST-segment depression in aVr as a predictor of culprit artery and infarct size in acute inferior wall ST-segment elevation myocardial infarction

ST-segment depression in aVr as a predictor of culprit artery and infarct size in acute inferior wall ST-segment elevation myocardial infarction

ST-segment depression in aVR as a predictor of culprit artery and infarct size in acute inferior wall ST-segment elevation myocardial infarction

Background ST-segment depression in lead aVR in acute inferior wall ST-segment elevation myocardial infarction (STEMI) has recently been suggested as a predictor of left circumflex (LCx) artery involvement. The purpose of this study is to evaluate the clinical significance of aVR depression during inferior wall STEMI. Methods This study included 106 consecutive patients who presented with inferior wall STEMI and underwent urgent coronary angiogram. Clinical and angiographic findings were compared between patients with and without aVR depression ≥0.1 mV. Results The sensitivity and specificity of aVR depression as a predictor of LCx infarction were 53% and 86%, respectively. In patients with right coronary artery infarction, aVR depression was associated with increased cardiac enzymes and the involvement of a large posterolateral branch, which may explain the larger infarction. Conclusions ST-segment depression in lead aVR in inferior wall STEMI predicts LCx infarction or larger RCA infarction involving a large posterolateral branch.

ST-segment resolution assessed immediately after primary percutaneous coronary intervention correlates with infarct size and left ventricular function in cardiac magnetic resonance at 1-year follow-up

Background Little is known about the predictive value of electrocardiographic ST-segment resolution (STR) assessed immediately after primary percutaneous coronary intervention (PCI). The aim of the study was to analyze the value of STR and maximum single-lead ST-segment elevation assessed immediately after primary PCI in prediction of infarct size and left ventricular function in cardiac magnetic resonance (CMR) at 1-year follow-up. Methods and results A total of 28 patients with anterior wall ST-segment elevation myocardial infarction treated with primary PCI entered the study. There was a significant correlation of STR and maximum single-lead ST-segment elevation assessed immediately after primary PCI and CMR infarct size and left ventricular function after 1 year. When analyzed according to standard optimal reperfusion cutoff (70% for STR and 1 mm for single-lead elevation), both electrocardiographic parameters were also good predictors of CMR infarct size and left ventricular function after 1 year. Conclusions ST-segment resolution and the single-lead maximum ST-segment elevation assessed immediately after primary PCI for ST-segment elevation myocardial infarction are good predictors of infarct size and left ventricular function in 1-year follow-up.

Portable enhanced external counterpulsation for Acute Coronary Syndrome and cardiogenic shock: A pilot study

Enhanced external counterpulsation (EECP) currently is used as an outpatient therapy for patients with refractory chronic angina. We sought to determine the safety and feasibility of a portable EECP unit to treat patients with acute coronary syndrome and/or cardiogenic shock in the coronary care unit (CCU). Ten patients with acute coronary syndrome and/or cardiogenic shock who were not considered candidates for invasive intra-aortic balloon counterpulsation (IABP) by the treating cardiologist were prospectively enrolled in this single-center study. Each patient received 2-4 one-hour EECP treatments performed at the bedside in the CCU. Anticoagulation or recent femoral access was not an exclusion criterion. The mean age was 58 +/- 19 years (range 28-81), and half were women. Patients had either acute coronary syndrome alone (n = 4), cardiogenic shock alone (n = 3), or both (n = 3). The cardiac indications for study enrollment included: acute inferior wall ST-segment elevation myocardial infarction with cardiogenic shock (n = 2), non-ST-segment elevation myocardial infarction with postinfarction angina (n = 2) or heart failure (n = 1), unstable angina with refractory rest angina (n = 2), cardiogenic shock from ischemic cardiomyopathy with severe mitral regurgitation (n = 1), and cardiogenic shock from nonischemic cardiomyopathy (n = 2). No adverse events were recorded during or as a consequence of EECP therapy, including no bleeding complications, no heart failure exacerbations, and no skin breakdown. The portable EECP unit did not interfere with ongoing critical care nursing. EECP is safe and feasible for acute bedside therapy of critically ill patients with acute coronary syndrome and/or cardiogenic shock who are not candidates for IABP.

Chicken's valve in a human heart

A 73-year-old woman was studied after admission for anterior wall ST-segment elevation myocardial infarction. Transthoracic echocardiography (GE Vingmed, Vivid 7, Horten, Norway) revealed what seemed to be a prolapsing posterior mitral leaflet (Panel A) with eccentric grade 2+ mitral regurgitation. However, 2D parasternal short-axis …