Fate of Patients With Prehospital Resuscitation for ST-Elevation Myocardial Infarction and a High Rate of Early Reperfusion Therapy (Results from the PREMIR [Prehospital Myocardial Infarction Registry])

Abstract Background The benefit of statins in secondary prevention of patients stabilized after acute coronary syndrome (ACS) has been well established. However, the benefit of preloading statins, i.e. high-intensity statins prior to reperfusion therapy remains unclear. Most previous studies included all types of ACS patients, and subgroup analysis indicated the benefit of preloading statins was only seen in ST-elevation myocardial infarction (STEMI) patients who underwent percutaneous coronary intervention (PCI). However, the sample size of subgroup population was relatively small and such benefit requires further validation. Objective To investigate the effect of loading dose of statins before primary reperfusion on 30-mortality in patients with STEMI. Methods We enrolled patients in China Acute Myocardial Infarction (CAMI) registry from January 2013 to September 2014. CAMI registry was a prospective multicenter registry of patients with acute acute myocardial infarction in China. Patients were divided into two groups according to statins usage: preloading group and control group. Patients in preloading group received loading does of statins before primary reperfusion and during hospitalization. Patients in control group did not receive statins during hospitalization or at discharge. Primary outcome was in-hospital mortality. Baseline characteristics, angiographic characteristics and outcome were compared between groups. Propensity score (PS) matching was used to mitigate baseline differences between groups and examine the association between preloading statins on in-hospital mortality risk. The following variables were used to establish PS matching score: age, sex, classification of hospitals, clinical presentation (heart failure at presentation, cardiac shock, cardiac arrest, Killip classification), hypertension, diabetes, prior angina, prior myocardial infarction history, prior stroke, initial treatment. Results A total of 1169 patients were enrolled in control group and 6795 in preloading group. A total of 833 patients (334 in control group and 499 in preloading group) died during hospitalization. Compared with control group, preloading group were younger, more likely to be male and present with Killip I classification. The proportion of hypertension and diabetes were higher in preloading group. After PS matching, all the variables used to generate PS score were well balanced. In the PS-matched cohort, 30-day mortality risk was 26.3% (292/1112) in the control group and 11.9% (132/1112) in the preloading group (p<0.0001). Conclusions The current study found preloading statins treatment prior to reperfusion therapy reduced in-hospital mortality risk in a large-scale contemporary cohort of patients with STEMI. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Chinese Academy of Medical Sciences

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Reperfusion strategy in Europe: temporal trends in performance measures for reperfusion therapy in ST-elevation myocardial infarction

European Heart Journal ◽

10.1093/eurheartj/ehq305 ◽

2010 ◽

Vol 31 (21) ◽

pp. 2614-2624 ◽

Cited By ~ 65

Author(s):

F. Schiele ◽

M. Hochadel ◽

M. Tubaro ◽

N. Meneveau ◽

W. Wojakowski ◽

...

Keyword(s):

Myocardial Infarction ◽

Performance Measures ◽

Temporal Trends ◽

Reperfusion Therapy ◽

St Elevation Myocardial Infarction ◽

St Elevation ◽

Reperfusion Strategy

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High risk electrocardiographic patterns in patients with acute coronary syndrome.

Archivos Peruanos de Cardiología y Cirugía Cardiovascular ◽

10.47487/apcyccv.v2i1.82 ◽

2020 ◽

Vol 2 (1) ◽

pp. 25-34

Author(s):

Diego Echeverri- Marín ◽

Cristhian Felipe Ramirez Ramos ◽

Andrés Miranda-Arboleda ◽

Gustavo Castilla-Agudelo ◽

Clara Saldarriaga-Giraldo

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Reperfusion Therapy ◽

Early Reperfusion ◽

St Segment Elevation ◽

Coronary Syndrome ◽

Acute Coronary Occlusion ◽

St Segment ◽

St Elevation ◽

Electrocardiographic Findings

Acute myocardial infarction is the leading cause of death in the world and the electrocardiogram remains the diagnostic tool for determining an acute myocardial infarction with ST-segment elevation. In spite of this, only half of the patients present classic electrocardiogram findings compatible with the ST-elevation infarction criteria. There is a spectrum of electrocardiographic findings that may reflect a phenomenon of acute coronary occlusion, which should be promptly recognized by the clinician to offer early reperfusion therapy.

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Prehospital delay and time to reperfusion therapy in ST elevation myocardial infarction

Journal of Emergencies Trauma and Shock ◽

10.4103/0974-2700.201580 ◽

2017 ◽

Vol 10 (2) ◽

pp. 64 ◽

Cited By ~ 9

Author(s):

RamaPrakasha Saya ◽

Linsha George ◽

Lakshmi Ramamoorthy ◽

Santhosh Satheesh ◽

D. K. S. Subrahmanyam

Keyword(s):

Myocardial Infarction ◽

Reperfusion Therapy ◽

St Elevation Myocardial Infarction ◽

Prehospital Delay ◽

St Elevation

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Abstract 108: Contemporary Timing and Etiology of Mortality in ST-Elevation Myocardial Infarction

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.13.suppl_1.108 ◽

2020 ◽

Vol 13 (Suppl_1) ◽

Author(s):

Zachary J Il'Giovine ◽

Anirudh Kumar ◽

Chetan Huded ◽

Venu Menon ◽

Amar Krishnaswamy ◽

...

Keyword(s):

Myocardial Infarction ◽

Hospital Discharge ◽

Systems Of Care ◽

Significant Risk ◽

Coronary Intervention ◽

St Elevation Myocardial Infarction ◽

Early Reperfusion ◽

St Elevation ◽

Long Term Mortality

Background: Acute treatment of ST-elevation myocardial infarction (STEMI) has focused on early reperfusion, prompt defibrillation, and appropriate mechanical support to mitigate short-term mortality. Long-term patterns of death in a contemporary population are not well described. Methods: We reviewed consecutive cases of STEMI treated with percutaneous coronary intervention (PCI) at our center between January 1, 2011, and December 31, 2016, and divided patients into two groups: uncomplicated STEMI (US) and complicated STEMI (CS). CS was defined by presence of cardiac arrest or cardiogenic shock, ascertained from first-medical-contact to device time for PCI. We assessed for differences in characteristics and short- and long-term mortality between the groups. Results: We identified 1,272 patients with STEMI; 214 of which were CS (16.8%). Those with CS were significantly more likely to have heart failure (22.9% vs 11.3%, p<0.001), kidney disease (38.2% vs. 21.0%, p<0.001), cerebrovascular disease (18.7% vs 11.0%, p=0.003), peripheral vascular disease (16.8% vs 7.9%, p<0.001), and left main or left anterior descending culprit vessel (51.9% vs. 40.3%, p<0.002). Total in-hospital mortality was 5.0% (63 patients), with 19.6% (42/214) and 2.0% (21/1058) of those with CS and US respectively (p<0.001). Among 1209 of patients that survived to hospital discharge, total long-term mortality was 10% (121 patients) of which 18.0% (31/172) had CS and 8.7% (90/1037) had US (p=0.001) over mean follow-up of 3.1±1.9 years. Of those, 52% and 50%, respectively, were from non-cardiovascular etiologies (Figure) including malignancy (13% vs. 22%), infection (22% vs. 19%), or other causes (17% vs. 9.0%). Conclusion: Despite advances in the in-hospital care of patients with STEMI, there remains a significant risk of long-term mortality for both patients with uncomplicated and complicated STEMI. A substantial proportion of overall STEMI mortality now occurs after hospital discharge predominantly due to non-cardiovascular causes. Systems of care to mitigate this long-term risk are needed.

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Shahid Gangalal National Heart Centre-ST-elevation Myocardial infarction Registry (SGNHC-STEMI-Registry), Nepal

Nepalese Heart Journal ◽

10.3126/njh.v17i1.28795 ◽

2020 ◽

Vol 17 (1) ◽

pp. 7-16

Author(s):

Chandra Mani Adhikari ◽

Kiran Prasad Acharya ◽

Reeju Manandhar ◽

Kunjang Sherpa ◽

Rikesh Tamrakar ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiogenic Shock ◽

Reperfusion Therapy ◽

St Elevation Myocardial Infarction ◽

Inferior Wall ◽

Cross Sectional ◽

Killip Class ◽

National Heart ◽

St Elevation ◽

Time Of Presentation

Background and Aims: Incidence of ST-elevation myocardial infarction (STEMI) is increasing in Nepal. We aim to describe the presentation, management, complications, and outcomes of patients admitted with a diagnosis of STEMI in Shahid Gangalal National Heart Centre (SGNHC), Nepal. Methods: Shahid Gangalal National Heart Centre-ST-elevation registry (SGNHC-STEMI) registry was a cross sectional, observational, registry. All the patients who were admitted with the diagnosis of STEMI from January 2018 to December 2018 were included. Results: In this registry, 1460 patients out of 1486 patients who attended emergency were included. The mean age of patients was 60.8±13.4 years (range: 20 years to 98 years) with 70.3% male patients. Most of the patients (83.2%) were referred from other hospitals and 16.8% of patients directly attended the SGNHC emergency. During the presentation, smoking (54%) was the most common risk factor, followed by hypertension (36.6%), diabetes mellitus (25.3%), and dyslipidemia (7.8%). After admission, new cases of dyslipidemia, HTN, Impaired Fasting Glucose (IFG), and Type 2 DM were diagnosed in 682 (51.3%), 182 (20.1%), 148 (10.3%) and 95 (8.9%) respectively. At the time of presentation, 73.3% were in Killip class I and 26.3% were above Killip class II with 5.1% in cardiogenic shock. Thirty-one percent of the cases received reperfusion therapy (Primary percutaneous intervention in 25.2% and fibrinolysis in 5.8%). Inferior wall MI was the most common type of STEMI. Among the patients who underwent invasive therapy, the multi-vessel disease was noted in 46.2% cases and left main coronary artery involvement in 0.7% cases. In-hospital mortality was 6.2% with cardiogenic shock being the most common cause. Aspirin (97.8%), clopidogrel (96.2%), statin (96.4%), ACEI/ARB (76.8%) and beta-blocker (76.8%) were prescribed during discharge. Conclusion: The SGNHC-STEMI registry provides valuable information on the overall aspect of STEMI in Nepal. In general, the SGNHC-STEMI registry findings are consistent with other international data.

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