scholarly journals The contemporary value of peak creatine kinase-MB after ST-segment elevation myocardial infarction above other clinical and angiographic characteristics in predicting infarct size, left ventricular ejection fraction, and mortality

2016 ◽  
Vol 40 (5) ◽  
pp. 322-328 ◽  
Author(s):  
Minke H. T. Hartman ◽  
Ruben N. Eppinga ◽  
Pieter J. J. Vlaar ◽  
Chris P. H. Lexis ◽  
Erik Lipsic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Creatine Kinase ◽  
Left Ventricular Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Creatine Kinase Mb

scholarly journals Importance of elevated heart rate in the very early phase of ST-segment elevation myocardial infarction: Results from the DANAMI-3 trial

2018 ◽  
Vol 8 (4) ◽  
pp. 318-328 ◽  
Author(s):  
Lars Nepper-Christensen ◽  
Jacob Lønborg ◽  
Kiril A Ahtarovski ◽  
Dan E Høfsten ◽  
Kasper Kyhl ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Rate ◽  
Left Ventricular Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Elevated Heart Rate

Background: Elevated heart rate is associated with poor clinical outcome in patients with acute myocardial infarction. However, in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention the importance of elevated heart rate in the very early phase remains unknown. We evaluated the impact of elevated heart rate in the very early pre-hospital phase of ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention on cardiovascular magnetic resonance markers of reperfusion success and clinical outcome. Methods: In this DANAMI-3 substudy, 1560 ST-segment elevation myocardial infarction patients in sinus rhythm without cardiogenic shock were included in the analyses of clinical outcome and 796 patients underwent cardiovascular magnetic resonance to evaluate area at risk, infarct size and left ventricular ejection fraction. Heart rate was assessed on the first electrocardiogram with ST-elevation (time of diagnosis). Results: Despite equal area at risk (33%±11 versus 36%±16, p=0.174) patients with a pre-hospital heart rate ⩾100 beats per minute developed larger infarcts (19% (interquartile range, 9–17) versus 11% (interquartile range, 10–28), p=0.001) and a lower left ventricular ejection fraction (54%±12 versus 58%±9, p=0.047). Pre-hospital heart rate ⩾100 beats per minute was independently associated with an increased risk of all-cause mortality and heart failure (hazard ratio 2.39 (95% confidence interval 1.58–3.62), p<0.001). Conclusions: Very early heart rate ⩾100 beats per minute in ST-segment elevation myocardial infarction was independently associated with larger infarct size, reduced left ventricular ejection fraction and an increased risk of all-cause mortality and heart failure, and thus serves as an easily obtainable and powerful tool to identify ST-segment elevation myocardial infarction patients at high risk.

scholarly journals Event-Free Survival Following Successful Percutaneous Intervention in Acute Myocardial Infarction Depends on Microvascular Perfusion

2020 ◽  
Vol 13 (6) ◽  
Author(s):  
Feng Xie ◽  
Lijun Qian ◽  
Andrew Goldsweig ◽  
Di Xu ◽  
Thomas R. Porter
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Left Ventricular Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary

Background: Although small trials have detected microvascular obstruction (MVO) with variable frequency following restoration of epicardial blood flow, the independent impact of abnormal microvascular perfusion (MVP) in predicting patient outcome following emergent percutaneous coronary intervention in acute ST-segment–elevation myocardial infarction is unknown. The study aims to determine the impact of abnormal MVP following successful epicardial recanalization in ST-segment–elevation myocardial infarction. Methods: MVP was analyzed by low mechanical index ultrasound imaging within 48 hours of emergent percutaneous coronary intervention in 297 patients with acute ST-segment–elevation myocardial infarction who had restoration of Thrombolysis in Myocardial Infarction grade 3 flow in the infarct vessel. Patients were divided into normal segmental replenishment (normal MVP) after high mechanical index impulses versus delayed replenishment but normal plateau intensity (delayed MVP) and both delayed replenishment and reduced plateau intensity (MVO by definition). Demographic variables, left ventricular ejection fraction change, and 5-year follow-up of death, recurrent myocardial infarction, and congestive heart failure were analyzed. Results: MVO was seen in 115 patients (39%), delayed MVP in 124 (42%), and normal MVP in 58 patients (19%). Patients with MVO had significant lower left ventricular ejection fraction change (39±12%) at hospital discharge compared with delayed MVP (50±10%; P =0.003) and normal MVP (57±8%; P <0.0001) groups. The MVO group also did not have an improvement in left ventricular ejection fraction change at 3-month follow-up (36±12% versus 37±13%; P =0.18). Both delayed MVP and MVO were independent predictors of adverse events at follow-up (hazard ratio, 21 [CI, 4–116]; P =0.001 and hazard ratio, 30 [CI, 5–183]; P <0.0001, respectively). Conclusions: Reduced or absent MVP following successful percutaneous coronary intervention in acute ST-segment–elevation myocardial infarction is common and associated with significantly worse outcome even with Thrombolysis in Myocardial Infarction 3 flow in the infarct vessel.

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