Impact of COVID-19 outbreak on regional STEMI care in Germany

Abstract Aims To assess the impact of the lockdown due to coronavirus disease 2019 (COVID-19) on key quality indicators for the treatment of ST-segment elevation myocardial infarction (STEMI) patients. Methods Data were obtained from 41 hospitals participating in the prospective Feedback Intervention and Treatment Times in ST-Elevation Myocardial Infarction (FITT-STEMI) study, including 15,800 patients treated for acute STEMI from January 2017 to the end of March 2020. Results There was a 12.6% decrease in the total number of STEMI patients treated at the peak of the pandemic in March 2020 as compared to the mean number treated in the March months of the preceding years. This was accompanied by a significant difference among the modes of admission to hospitals (p = 0.017) with a particular decline in intra-hospital infarctions and transfer patients from other hospitals, while the proportion of patients transported by emergency medical service (EMS) remained stable. In EMS-transported patients, predefined quality indicators, such as percentages of pre-hospital ECGs (both 97%, 95% CI = − 2.2–2.7, p = 0.846), direct transports from the scene to the catheterization laboratory bypassing the emergency department (68% vs. 66%, 95% CI = − 4.9–7.9, p = 0.641), and contact-to-balloon-times of less than or equal to 90 min (58.3% vs. 57.8%, 95%CI = − 6.2–7.2, p = 0.879) were not significantly altered during the COVID-19 crisis, as was in-hospital mortality (9.2% vs. 8.5%, 95% CI = − 3.2–4.5, p = 0.739). Conclusions Clinically important indicators for STEMI management were unaffected at the peak of COVID-19, suggesting that the pre-existing logistic structure in the regional STEMI networks preserved high-quality standards even when challenged by a threatening pandemic. Clinical trial registration NCT00794001

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Resolution of ST-Segment Depression In Reciprocal Leads As Predictor Mayor Adverse Cardiac Event For ST-Segment Elevation Myocardial Infarction With Fibrinolytic Therapy

Indonesian Journal of Cardiology ◽

10.30701/ijc.v39i2.735 ◽

2019 ◽

Vol 39 (2) ◽

Author(s):

Aldino Satria Adhitya ◽

Andika Sitepu ◽

Zulfikri Mukhtar ◽

Harris Hasan

Keyword(s):

Myocardial Infarction ◽

Fibrinolytic Therapy ◽

Dominant Factor ◽

Bivariate Analysis ◽

St Segment Elevation ◽

St Segment ◽

Significant Difference ◽

Determining Factors ◽

St Elevation ◽

Determining Factor

Background: ST Elevation Myocardial Infarction (STEMI) may cause Major Cardiovascular Event (MACE). Revascularization needs to be done in all STEMI patients to restore coronary blood flow, hence saving myocardial perfusion. ST Segment Depression (STSD) in reciprocal ECG lead is associated with poor prognosis in STEMI patients receiving fibrinolytic therapy. The main purpose of this study is to evaluate MACE in STEMI patients receiving fibrinolytic therapy using resolution in STSD. Methods: This cohort prospective study with 60 subjects of STEMI patients which are evaluated for MACE (death, heart failure, and rehospitalization) within 30 days after myocardial infarction. Resolution in STSD is defined as resolution ≥ 50% STSD in reciprocal leads within 90 minutes after fibrinolytic therapy.Results: Bivariate analysis showed that Ejection fraction (EF) <40% with OR 8,32 (2,11-32,74), p=0,001; smoking with OR 4,17 (1,05-16,57), p=0,034; Anterior STEMI with OR 3,94 (1,11-13,90), p= 0,027; Creatinine > 1,97 mg/dl with OR 3,69 (1,18-11,55), p= 0,022; complete outpatient medication with OR 5,23 (1,61-17,01), p= 0,004; fragmented QRS with OR 5,23 (1,61-17,01), p= 0,001; resolution in STSD with OR 26,35 (5,16-134, 40), p=<0,001; resolution in ST Segment Elevation with OR 10,5 (2,97-37,24), p=<0,001; are proven to be determining factor for MACE within 30 days. Multivariate analysis showed that among those determining factors for MACE, resolution in STSD on reciprocal leads is evidently the most dominant factor for predicting MACE within 30 days in STEMI patients receiving fibrinolytic therapy [OR 11.47 (1.14-115.10), p=0.038].Conclusion: There is significant difference in MACE within 30 days after myocardial infarction (MI) between patients with and without resolution in STSD. The subjects without resolution in STSD showed higher MACE incidence. Resolution in STSD is evidently an independent predictor for MACE within 30 days after myocardial infarction in STEMI patients.Keywords: Resolution in STSD, MACE, STEMI, Fibrinolytic

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Profil lipid pada wanita dengan sindrom koroner akut

JURNAL BIOMEDIK (JBM) ◽

10.35790/jbm.8.2.2016.12666 ◽

2016 ◽

Vol 8 (2) ◽

Author(s):

Ronaldi . ◽

Ike Adriana ◽

Monique Rotty ◽

Reginald L. Lefrandt ◽

Agnes L. Panda

Keyword(s):

Myocardial Infarction ◽

High Density Lipoprotein ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Low Density ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

St Elevation ◽

The Mean

Abstract: Females with acute coronary syndrome (ACS) display different characteristics from the opposite gender. Currently, only limited data were available regarding the characteristic of ACS in females, especially in Manado. This study aimed to obtain the lipid profile of females with ACS at Prof. Dr. R. D. Kandou Hospital Manado in 2012-2013. This was a descriptive retrospective study with a cross sectional design. Subjects were all female patients with ACS who were admitted to Prof. Dr. R. D. Kandou Hospital Manado from January 2012 to December 2013. Data were collected based on the medical record. Exclusion criteria included incomplete data and non-ACS as the main diagnosis. There were 81 women as subjects in this study. The mean age was 61.59±10.78 years. Unstable angina pectoris, non-ST elevation myocardial infarction, ST elevation myocardial infarction were found in 38 (46.9%), 15 (18.5%), and 28 (34.6%) patients consecutively. Mean value of total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), and trygliserida levels were as follows: 218.17±48.88, 145.91±47.30, 39.72±15.99, and 153±65.55 mg/dl. High level of total cholesterol, LDL, and trygliserida were found in 52 (64.2%), 50 (61.7%), 14 (17.3%) patients consecutively meanwhile low HDL level was found in 51(63%) patients. Diabetes mellitus and hypertension were found in 24 (29.6%) and 58 (71.6%) patients. The mean length of stay was 8.44±4.36 days.Keywords: female, lipid profile, acute coronary syndromeAbstrak: Wanita dengan sindrom koroner akut (SKA) menampilkan karakteristik yang berbeda daripada laki-laki dengan SKA. Sampai saat ini, masih tersedia sedikit data mengenai karakteristik SKA pada wanita. Penelitian ini bertujuan mendapatkan gambaran profil lipid pada wanita dengan SKA yang dirawat di RSUP Prof. Dr. R. D. Kandou. Jenis penelitian ini deskriptif retrospektif dengan desain potong lintang. Subyek penelitian ialah pasien wanita dengan SKA yang dirawat di RSUP Prof. Dr. R. D. Kandou, Manado dari Januari 2012-Desember 2013. Data dikumpulkan dari rekam medis. Kriteria eksklusi meliputi data yang tidak lengkap dan diagnosis selain SKA sebagai diagnosis utama. Hasil penelitian mendapatkan subyek 81 pasien wanita dengan usia rata-rata 61,59±10,78 tahun. Angina pektoris tak stabil ditemukan pada 38 pasien (46,9%), non-ST segment elevation myocardial infarction pada 15 pasien (18,5%), dan ST segment elevation myocardial infarction pada 28 pasien (34,6%). Kadar rerata kolesterol total, low density lipoprotein (LDL), high density lipoprotein (HDL), dan trigliserida ialah berturut-turut 218,17±48,88, 145,91±47,30, 39,72±15,99, dan 153±65,55 mg/dl. Kadar kolesterol total, LDL, trigliserida yang tinggi ditemukan berturut-turut pada 52 pasien (64,2%), 50 pasien (61,7%), dan 14 pasien (17,3%) sedangkan kadar HDL yang rendah ditemukan pada 51 pasien (63%). Diabetes melitus dan hipertensi ditemukan pada 24 pasien (29,6%) dan 58 pasien (71,6%). Rerata lama perawatan di rumah sakit ialah 8,44±4,36 hari.Kata kunci: wanita, profil lipid, sindrom koroner akut

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Correlation of Severity of ST Segment Elevation with Respect to the Site of Right Coronary Artery Lesion

Journal of Nepal Medical Association ◽

10.31729/jnma.2031 ◽

2013 ◽

Vol 52 (191) ◽

Author(s):

Rabindra Simkhada

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Inferior Wall ◽

St Segment Elevation ◽

St Segment ◽

Infarct Related Artery ◽

St Elevation ◽

The Mean ◽

St Segments ◽

Lesion Severity

Introduction: Electrocardiogram a widely available tool may predict infarct related artery in acute inferior wall myocardial infarction. Severity of ST segment elevation may correlate with proximity of lesion in right coronary artery.Methods: Patient with acute ST segment elevation inferior wall myocardial infarction who underwent coronary angiogram was studied. Differences in electrocardiogram among right coronary and left circumflex groups were evaluated. Severity of ST segments elevation in relation to site of lesion in right coronary was studied.Results: The mean age of presentation was 59.52 ± 11.01 years. Total 36 (72%) were men. A total of 42 (84%) had lesion in right and 8 (16%) in left circumflex. Age, sex,diabetes,hypertension, smoking, dyslipidemia and physical activity showed no correlation with lesion in right or circumflex coronary artery. ST segment elevation in III>II (P=0.01), ST segment depression in AVL> I (P<0.01) and ST elevation in V4R (P=0.04), correlated with right coronary lesion. Sum of ST elevation in inferior leads were 10.90 ±1.30 mm for proximal, 7.38±1.19 mm for mid and 5.50± 0.53 mm for distal right coronary with significant correlation (P<0.01).Conclusions: Electrocardiogram was reliable tool to difference right and left circumflex lesion. Severity of sum of ST segment elevations in inferior leads correlated with the proximity of lesion in right coronary._______________________________________________________________________________________Keywords: acute inferior myocardial infarction; electrocardiogram; infarct related artery._______________________________________________________________________________________

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The Significance of Dynamics of ST Segment Changes When Assessing the Effectiveness of Mechanical Reperfusion of the Myocardium in Hyperglycaemic Patients with Acute Myocardial Infarction with Persistent ST-Segment Elevation

Journal of Integrative Cardiology Open Access ◽

10.31487/j.jicoa.2020.01.08 ◽

2020 ◽

pp. 1-6

Author(s):

Marek Andres ◽

Maciej Małecki ◽

Ewa Konduracka ◽

Jacek Legutko ◽

Janusz Andres ◽

...

Keyword(s):

Myocardial Infarction ◽

Blood Glucose ◽

Coronary Intervention ◽

Glucose Metabolism Disorders ◽

St Segment Elevation ◽

Glucose Levels ◽

St Segment ◽

Significant Difference ◽

St Elevation

Background: The coexistence of coronary heart disease and consequently, acute myocardial infarction with persistent ST-segment elevation (STEMI) and glucose metabolism disorders is well known. Still, glucose metabolism disorders in the STEMI population are not fully understood. We know that diabetes mellitus (DM) is a factor disabling the function of microcirculation, which in turn may affect the outcome of coronary intervention. The aim of this study was to evaluate the dynamics of ST-segment changes in ECG (electrocardiogram) in STEMI (ST-segment elevation myocardial infarction) patients with co-existing hyperglycaemia compared to those with normoglycaemia treated with a percutaneous coronary intervention (PCI), as well as to determine this parameter in the assessment of reperfusion effectiveness. Methods: The study included 92 patients with the diagnosis of STEMI enrolled in the PCI treatment and was divided into groups based on the glucose levels on admission (reactive hyperglycaemia): a group with higher glucose levels on admission (Glc ≥ 7.8 mmol/L, n = 46), a group with lower glucose levels on admission (Glc < 7.8 mmol/L, n = 46) and into groups based on the concentration of HbA1c: a group with a lower HbA1c level (<6.5% (48 mmol/mol), n=71) and a group with a higher level (≥6.5%, n=21). Results: On admission, there were no significant differences in terms of clinical characteristics between the groups of patients with normoglycemia and reactive hyperglycaemia. After PCI, the patients with normoglycemia had significantly higher (p = 0.021) dynamics of changes in the resolution of ST-segment elevation in ECG expressed in an indicator of sum STR (resolution of ST-elevation). A degree of resolution of ST elevation in ECG was significantly (p = 0.021) dependent on the level of blood glucose – higher the blood glucose level, weaker the resolution. The patients with glucose levels ≥7.8 mmol/L had significantly higher levels of CK and CK-MB during the first 48 hours of hospitalization. There was a statistically significant difference in the mean length of hospitalization between individuals from the group with lower and higher blood glucose levels on admission (p = 0.028). A 4-month follow-up revealed no significant difference in the incidence of major adverse cardiovascular events (MACE) in the study groups (p = 0.063). A 4-year follow-up of patients with higher levels of blood glucose on admission showed a higher incidence of MACE (p = 0.01). The patients with HbA1c ≥ 6.5% were older (p = 0.004), had a greater BMI > 30kg/m2 (p=0.019) and the lower ejection fraction of the left ventricle (p = 0.003) compared to those with the HbA1c levels <6.5%. The incidence of MACE in 4-month and 4-year follow-up was comparable in the study population.

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Effect of sulfonylureas on attenuation of electrocardiographic ST- segment elevation during an acute myocardial infarction in diabetics

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20180969 ◽

2018 ◽

Vol 7 (4) ◽

pp. 579

Author(s):

Bapugouda Sahebagouda Patil ◽

Naser Ashraf Tadvi

Keyword(s):

Diabetes Mellitus ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Control Group ◽

Diabetic Patients ◽

Study Group ◽

St Segment Elevation ◽

St Segment ◽

Significant Difference ◽

The Mean

Background: Sulfonylureas are primarily used in the treatment of diabetes mellitus act by inhibiting ATP sensitive potassium ATP (K-ATP) channels. Similar channels are also present are also present in heart venticular muscle. Previous studies reveal that these drugs are able to reduce the electrocardiographic ST- segment elevation changes during an acute myocardial infarction. Hence, the present study was designed to evaluate the attenuating effect of sulfonylureas on ST- segment elevation in diabetic patients presenting with acute myocardial infarction.Methods: This cross sectional study included 73 diabetic patients presenting with the signs and symptoms of acute myocardial infarction of less than 24 hours duration along with CPK levels of more than 25 IU/L. Of them 5 were excluded from the study. The remaining 68 patients were included in the study, out of which 36 patients were in the study group (sulfonylurea group), and 32 patients were in the control group (non-sulfonylurea group).Results: No statistically significant difference was seen in the demographic parameters like age, sex, duration of diabetes mellitus and CPK levels (p>0.05). Among 68 patients 38 patients were diagnosed as STEMI. The mean magnitude of ST-elevation in the study group (n=16) was 2.3±0.12 and in control group (n=22) patients it was 3.7±0.33. The percentage of NSTEMI was significantly higher in study group compared to control. Statistically significant difference (p<0.05) was seen only between CPK level of range 25 and 100IU/L and mean magnitude of ST-segment elevation in STEMI patients. Significant difference in the mean magnitude of ST-segment elevation was observed in case of females among the study and control groups (p<0.05).Conclusions: Sulfonylureas drugs play a significant role in attenuation of ST-segment in diabetic patients presenting with acute myocardial infarction. Further, large multicentric studies are required to confirm the exact correlation between sulfonylureas and ST-segment.

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Who Has Seen Patients With ST‐Segment–Elevation Myocardial Infarction? First Results From Italian Real‐World Coronavirus Disease 2019

Journal of the American Heart Association ◽

10.1161/jaha.120.017126 ◽

2020 ◽

Vol 9 (19) ◽

Author(s):

Valeria Cammalleri ◽

Saverio Muscoli ◽

Daniela Benedetto ◽

Giuseppe Stifano ◽

Massimiliano Macrini ◽

...

Keyword(s):

Myocardial Infarction ◽

Left Ventricular ◽

Cardiac Biomarkers ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

St Segment Elevation ◽

Catheterization Laboratory ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

The Impact

Background After the coronavirus disease 2019 outbreak, social isolation measures were introduced to contain infection. Although there is currently a slowing down of the infection, a reduction of hospitalizations, especially for myocardial infarction, was observed. The aim of our study is to evaluate the impact of the infectious disease on ST‐segment–elevation myocardial infarction (STEMI) care during the coronavirus disease 2019 pandemic, through the analysis of recent cases of patients who underwent percutaneous coronary intervention. Methods and Results Consecutive patients affected by STEMI from March 1 to 31, 2020, during social restrictions of Italian government, were collected and compared with patients with STEMI treated during March 2019. During March 2020, we observed a 63% reduction of patients with STEMI who were admitted to our catheterization laboratory, when compared with the same period of 2019 (13 versus 35 patients). Changes in all time components of STEMI care were notably observed, particularly for longer median time in symptom‐to‐first medical contact, spoke‐to‐hub, and the cumulative symptom‐to‐wire delay. Procedural data and in‐hospital outcomes were similar between the 2 groups, whereas the length of hospitalization was longer in patients of 2020. In this group, we also observed higher levels of cardiac biomarkers and a worse left ventricular ejection fraction at baseline and discharge. Conclusions The coronavirus disease 2019 outbreak induced a reduction of hospital access for STEMI with an increase in treatment delay, longer hospitalization, higher levels of cardiac biomarkers, and worse left ventricular function.

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Unique role of admission hyperglycemia on myocardial infarction size and area at risk following an acute ST-elevation myocardial infarction

The Egyptian Journal of Internal Medicine ◽

10.1186/s43162-020-00015-y ◽

2020 ◽

Vol 32 (1) ◽

Author(s):

Taghreed Sayed Meshref ◽

Mahmoud Aly Ashry ◽

Refaat Fathi Abd El-Aal ◽

Hisham Mostafa Imam ◽

Dina Ali Hamad

Keyword(s):

Myocardial Infarction ◽

At Risk ◽

St Elevation Myocardial Infarction ◽

Diabetic Patients ◽

Area At Risk ◽

St Segment Elevation ◽

Infarction Size ◽

St Segment ◽

St Elevation ◽

The Impact

Abstract Background Hyperglycemia can adversely affect patients with acute ST-elevation myocardial infarction (STEMI) in both diabetic and non-diabetic patients. The majority of the studies had investigated the impact of admission hyperglycemia (AH) on cardiovascular morbidity and mortality while, in ours, we entailed its impact on final infarction size (FIS) and more interestingly, on the area at risk (AAR), both were estimated by cardiac magnetic resonance (CMR) imaging. Results AH showed significant positive correlations to FIS and AAR. Moreover, AH group had higher summation of ST segment elevation (sum STE), more maximum ST segment elevation (max STE), higher echocardiographic wall motion score index (WMSI), higher CMR estimated WMSI, and lower segmental ejection fraction (EF). Multivariate analysis showed that AH was independently associated with increased FIS. Conclusion Current study showed an association between AH and large FIS in STEMI patients.

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Abstract 6181: ST Segment Resolution and Pathological Findings of Aspirated Materials in Patients with ST Elevation Acute Myocardial Infarction

Circulation ◽

10.1161/circ.118.suppl_18.s_1076-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Asami Suzuki ◽

Tsunekazu Kakuta ◽

Taishi Yonetsu ◽

Tetsumin Lee ◽

Taro Iwamoto ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Pathological Findings ◽

Timi Flow Grade ◽

St Segment Elevation ◽

St Segment ◽

Significant Difference ◽

St Elevation ◽

Organized Thrombus ◽

Elevation Acute Myocardial Infarction

Early resolution of ST-segment elevation (STR) is a potent predictor of better clinical outcome after PCI in ST elevation acute myocardial infarction (STEMI). The aim of this study was to determine the association of aspirated materials and serial change of ST elevation. We studied 150 consecutive STEMI patients with assessable ECG recording, in whom standard PCI was performed with the adjunctive use of aspiration thrombectomy. STR(+) was defined as more than 50% resolution of ST-segment elevation at 60min after PCI. Aspirated materials were pathologically classified into thrombus only group (fresh, lytic, or organized) or thrombus and atheroma complex group, and compared between STR(+) and STR(−). TIMI flow grade, IVUS findings after aspiration(ruptured plaque, calcification, thrombus and echo signal attenuation), area under the curve (AUC) of CK-MB release, and pathological findings were also compared between the two groups. Seventy-six patients (50.6%) showed STR and 74 patients didn’t. RCA culprit lesion was significantly more frequent in STR(+)(P<0.05). There was no significant difference in other patient characteristics or IVUS findings in the present cohort. AUC of CK-MB was lower in STR(+)(p=0.02). TIMI 3 flow was more frequently achieved in STR(+)(p<0.05). Fresh thrombus was more frequent in STR(+)(p<0.05), whereas atheromatous component and lytic or organized thrombus were frequently observed in STR(−)(p<0.05). Culprit lesions in STEMI, when atheroma and thrombus complex with lytic or organized thrombus was aspirated, caused more myocardial damage and less frequent STR.

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Direct Admission of Patients With ST‐Segment–Elevation Myocardial Infarction to the Catheterization Laboratory Shortens Pain‐to‐Balloon and Door‐to‐Balloon Time Intervals but Only the Pain‐to‐Balloon Interval Impacts Short‐ and Long‐Term Mortality

Journal of the American Heart Association ◽

10.1161/jaha.120.018343 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Simcha R. Meisel ◽

Michael Kleiner‐Shochat ◽

Rami Abu‐Fanne ◽

Aaron Frimerman ◽

Asaf Danon ◽

...

Keyword(s):

Myocardial Infarction ◽

Emergency Department ◽

Logistic Regression ◽

St Segment Elevation ◽

Catheterization Laboratory ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Direct Admission ◽

Door To Balloon ◽

The Impact

Background Shortening the pain‐to‐balloon (P2B) and door‐to‐balloon (D2B) intervals in patients with ST‐segment–elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PPCI) is essential in order to limit myocardial damage. We investigated whether direct admission of PPCI‐treated patients with STEMI to the catheterization laboratory, bypassing the emergency department, expedites reperfusion and improves prognosis. Methods and Results Consecutive PPCI‐treated patients with STEMI included in the ACSIS (Acute Coronary Syndrome in Israel Survey), a prospective nationwide multicenter registry, were divided into patients admitted directly or via the emergency department. The impact of the P2B and D2B intervals on mortality was compared between groups by logistic regression and propensity score matching. Of the 4839 PPCI‐treated patients with STEMI, 1174 were admitted directly and 3665 via the emergency department. Respective median P2B and D2B were shorter among the directly admitted patients with STEMI (160 and 35 minutes) compared with those admitted via the emergency department (210 and 75 minutes, P <0.001). Decreased mortality was observed with direct admission at 1 and 2 years and at the end of follow‐up (median 6.4 years, P <0.001). Survival advantage persisted after adjustment by logistic regression and propensity matching. P2B, but not D2B, impacted survival ( P <0.001). Conclusions Direct admission of PPCI‐treated patients with STEMI decreased mortality by shortening P2B and D2B intervals considerably. However, P2B, but not D2B, impacted mortality. It seems that the D2B interval has reached its limit of effect. Thus, all efforts should be extended to shorten P2B by educating the public to activate early the emergency medical services to bypass the emergency department and allow timely PPCI for the best outcome.

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