ST-Segment Elevation in Out-of-Hospital Cardiac Arrest Survivors Not Always Related to Obstructive Coronary Artery Disease

2018 ◽  
Vol 121 (11) ◽  
pp. 1445-1447
Author(s):  
Marin Pavlov ◽  
Zdravko Babić
Keyword(s):  
Coronary Artery Disease ◽  
Cardiac Arrest ◽  
Coronary Artery ◽  
Obstructive Coronary Artery Disease ◽  
St Segment Elevation ◽  
St Segment ◽  
Artery Disease ◽  
Hospital Cardiac Arrest

scholarly journals Infarct-related chronic total coronary occlusion and the risk of ventricular tachyarrhythmic events in out-of-hospital cardiac arrest survivors

2021 ◽  
Author(s):  
M. van der Graaf ◽  
L. S. D. Jewbali ◽  
J. S. Lemkes ◽  
E. M. Spoormans ◽  
M. van der Ent ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cardiac Arrest ◽  
Coronary Artery ◽  
Coronary Occlusion ◽  
Independent Factor ◽  
St Segment Elevation ◽  
St Segment ◽  
Artery Disease ◽  
Chronic Total Coronary Occlusion ◽  
Hospital Cardiac Arrest

Abstract Introduction Chronic total coronary occlusion (CTO) has been identified as a risk factor for ventricular arrhythmias, especially a CTO in an infarct-related artery (IRA). This study aimed to evaluate the effect of an IRA-CTO on the occurrence of ventricular tachyarrhythmic events (VTEs) in out-of-hospital cardiac arrest survivors without ST-segment elevation. Methods We conducted a post hoc analysis of the COACT trial, a multicentre randomised controlled trial. Patients were included when they survived index hospitalisation after cardiac arrest and demonstrated coronary artery disease on coronary angiography. The primary endpoint was the occurrence of a VTE, defined as appropriate implantable cardioverter-defibrillator (ICD) therapy, sustained ventricular tachyarrhythmia or sudden cardiac death. Results A total of 163 patients from ten centres were included. Unrevascularised IRA-CTO in a main vessel was present in 43 patients (26%). Overall, 61% of the study population received an ICD for secondary prevention. During a follow-up of 1 year, 12 patients (7.4%) experienced at least one VTE. The cumulative incidence rate of VTEs was higher in patients with an IRA-CTO compared to patients without an IRA-CTO (17.4% vs 5.6%, log-rank p = 0.03). However, multivariable analysis only identified left ventricular ejection fraction < 35% as an independent factor associated with VTEs (adjusted hazard ratio 8.7, 95% confidence interval 2.2–35.4). A subanalysis focusing on CTO, with or without an infarct in the CTO territory, did not change the results. Conclusion In out-of-hospital cardiac arrest survivors with coronary artery disease without ST-segment elevation, an IRA-CTO was not an independent factor associated with VTEs in the 1st year after the index event.

scholarly journals Ventricular Rupture due to Myocardial Infarction without Obstructive Coronary Artery Disease

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Hendrik Lapp ◽  
Marcel Keßler ◽  
Thomas Rock ◽  
Franz X. Schmid ◽  
Dong-In Shin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Obstructive Coronary Artery Disease ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
St Segment ◽  
Ventricular Rupture ◽  
Life Threatening ◽  
Artery Disease

An 87-year-old woman presenting with myocardial infarction and ST-segment elevation in the electrocardiogram suffered from pericardial effusion due to left ventricular rupture. After ruling out obstructive coronary artery disease and aortic dissection, she underwent cardiac surgery showing typical infarct-macerated myocardial tissue in situ. This case shows that even etiologically unclear and small-sized myocardial infarctions can cause life-threatening mechanical complications.

Relation of vascular dilator function and cardiac autonomic function with coronary angiography findings in patients with non-ST segment elevation acute coronary syndrome

2020 ◽  
pp. 204887262091871
Author(s):  
Gaetano Antonio Lanza ◽  
Eleonora Ruscio ◽  
Gessica Ingrasciotta ◽  
Tamara Felici ◽  
Monica Filice ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Obstructive Coronary Artery Disease ◽  
Cardiac Autonomic Function ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Elevation Acute Coronary Syndrome ◽  
Artery Disease

Background A sizeable number of patients with a diagnosis of non-ST segment elevation acute coronary syndrome show non-obstructive coronary artery disease. In this study we assessed whether differences in vascular and cardiac autonomic function exist between non-ST segment elevation acute coronary syndrome patients with obstructive or non-obstructive coronary artery disease. Methods and results Systemic endothelium-dependent and independent vascular dilator function (assessed by flow-mediated dilation and nitrate-mediated dilation of the brachial artery, respectively) and cardiac autonomic function (assessed by time-domain and frequency-domain heart rate variability parameters) were assessed on admission in 120 patients with a diagnosis of non-ST segment elevation acute coronary syndrome. Patients were divided into two groups according to coronary angiography findings: (a) 59 (49.2%) with obstructive coronary artery disease (≥50% stenosis in any epicardial arteries); (b) 61 (50.8%) with non-obstructive coronary artery disease. No significant differences between the two groups were found in both flow-mediated dilation (5.03 ± 2.6 vs. 5.40 ± 2.5%, respectively; P = 0.37) and nitrate-mediated dilatation (6.79 ± 2.8 vs. 7.30 ± 3.4%, respectively; P = 0.37). No significant differences were also observed between the two groups both in time-domain and frequency-domain heart rate variability variables, although the triangular index tended to be lower in obstructive coronary artery disease patients (30.2 ± 9.5 vs. 33.9 ± 11.6, respectively; P = 0.058). Neither vascular nor heart rate variability variables predicted the recurrence of angina, requiring emergency room admission or re-hospitalisation, during 11.3 months of follow-up. Conclusions Among patients admitted with a diagnosis of non-ST segment elevation acute coronary syndrome we found no significant differences in systemic vascular dilator function and cardiac autonomic function between those with obstructive coronary artery disease and those with non-obstructive coronary artery disease.

scholarly journals Profile of a patient with non-ST segment elevation myocardial infarction in actual clinical practice

2021 ◽  
Vol 26 (2) ◽  
pp. 4071
Author(s):  
V. V. Ryabov ◽  
A. E. Gombozhapova ◽  
S. V. Demyanov
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Artery Stenosis ◽  
Obstructive Coronary Artery Disease ◽  
Myocardial Revascularization ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Male Patients ◽  
Artery Disease

Aim. To describe profile of a modern portrait with non-ST-segment elevation myocardial infarction (non-STEMI) through a comprehensive analysis of the Emergency Cardiology Unit (ECU) practice, which discharge a function of a regional vascular centre.Material and methods. To describe the non-STEMI trends of the last decade, we analysed the annual reports on ECU work. The main analysis included patients with a documented non-STEMI treated in 2019 (n=221). We used information from the department database. A Microsoft Excel software was used to create the database. The base has been filled in by the ECU head in real time since 2009. Statistical data processing was performed using the Statistica 10,0 software package. The methods of descriptive statistics and Yates-corrected chi-square test were used.Results. The following clinical and demographic trends of the last decade were revealed: an increase in the number of patients with non-STEMI, proportion of male patients, mean age of patients, proportion of patients with MI with non-obstructive coronary artery disease; no decrease in in-hospital mortality, despite the introduction of modern guidelines, pharmacological and invasive treatment of non-STEMI. In 2019, the proportion of male patients and patients 75 years and older was 62,4% and 32%, respectively. The mean age of patients was 64,6±13,0 years. Clopidogrel was the predominant P2Y12 receptor blockers (56,1%). A total of 176 patients (79,6%) underwent the invasive procedures. Endovascular myocardial revascularization was performed in 97 patients (43,9%), while in the group over 75 years old — in 16 (7%) patients. The leading causes for absence of myocardial revascularization were chronic kidney disease (4,6%), severe coronary artery disease (6,3%), “borderline” (50-60%) coronary artery stenosis. The overall in-hospital mortality rate was 9,0%, while in the group of patients over 75 years old — 19,7%. Mortality rates did not differ in patients with and without myocardial revascularization (p=0,2). However, the incidence of pulmonary oedema was higher in the conservative treatment group (p=0,04).Conclusion. Treatment of patients 75 years and older remains the main barrier in management of patients with non-STEMI. We observe the treatment-risk paradox, which consists in choosing a less aggressive treatment strategy in the group of the most high-risk patients. Other relevant aspects in the management of non-STEMI patients are the selection of a method for myocardial revascularization in multivessel coronary artery disease, assessment of the hemodynamic significance of coronary artery stenosis, and patients with non-obstructive coronary artery disease.

scholarly journals Myocardial infarction in the absence of obstructive coronary artery disease (MINOCA): A Challenge to Diagnose and Manage

2020 ◽  
Vol 3 (13) ◽  
pp. 01-04
Author(s):  
Meera D Kondapaneni ◽  
Ahmad Jabri ◽  
Aisha Siraj ◽  
Saima Karim
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Obstructive Coronary Artery Disease ◽  
Troponin Elevation ◽  
Ischemic Event ◽  
St Segment Elevation ◽  
St Segment ◽  
Underlying Causes ◽  
Artery Disease

Myocardial Infarction in the absence of obstructive coronary artery disease [MINOCA] is seen in 5-6% of the patients presenting with myocardial infarction. While patients with MINOCA can present with either ST segment elevation or non-ST segment elevation myocardial infarction, they are less likely to have ST segment deviation on electrocardiography and have less of cardiac biomarker elevation compared to their obstructive coronary artery disease counterparts. Patients with MINOCA are usually younger and with lower prevalence of traditional cardiovascular risk factors compared with patients presenting with obstructive coronary artery disease. A variety of atherosclerotic and non-atherosclerotic mechanisms can lead to MINOCA. A diagnosis of MINOCA can only be made in patients whose clinical presentation is attributed to an ischemic event after excluding obstructive coronary artery disease and alternate causes for troponin elevation. A systematic approach to diagnosing the underlying causes is warranted to optimally treat patients presenting with MINOCA.

P2266The predictor of mortality and neurological outcome in out-of-hospital cardiac arrest patients with non-ST-segment elevation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Matsuda ◽  
G Nitta ◽  
S Kato ◽  
T Kono ◽  
T Ikenouchi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Coronary Artery ◽  
Neurological Outcome ◽  
Past History ◽  
Good Neurological Outcome ◽  
St Segment Elevation ◽  
St Segment ◽  
History Of ◽  
Artery Disease ◽  
Hospital Cardiac Arrest

Abstract Background The prognosis of patients with out-of-hospital cardiac arrest (OHCA) remains poor. Coronary artery disease (CAD) is the most frequent cause of OHCA. The prompt evaluation and revascularization for coronary artery in OHCA patients with ST-segment elevation are recommended because they often have CAD. However, OHCA patients without ST-segment elevation also have any coronary stenosis in the non-negligible proportion. The predictor of mortality and neurological outcome in OHCA patients with no ST-segment elevation has not been sufficiently elucidated. Purpose We sought to investigate the predictor of mortality and neurological outcome at 30 days in OHCA patients without ST-segment elevation. Methods A total of 1382 out-of-hospital cardiac arrest patients were transferred to our critical care center, of which 252 cardiovascular arrest patients achieving the return of spontaneous circulation (ROSC) were extracted from the institutional consecutive database between January 2015 and December 2018. Among those patients, 183 patients' electrocardiogram after ROSC were without ST-segment elevation. We performed coronary angiography (CAG) for 103 patients, who were eligible for final analysis. To predict mortality in hospital and neurological outcome at 30 days, we investigated basic patients' characteristics, pre-hospital information, post-hospital care. Results Any coronary stenosis was founded in 50 patients (48.5%). Male (P=0.007), older age (P<0.001), past history of coronary artery disease (CAD) (P=0.037) and diabetes mellitus (P=0.087) were associated with coronary artery stenosis on CAG findings. Age (OR 1.05; 95% confidence interval (CI) 1.02–1.08; P<0.001), male (OR 5.33; 95% CI 1.37–20.7; P<0.001) were independent predictors of coronary artery stenosis. Among those who had stenosis, 34 patients (68.0%) survived and 27 patients (54.0%) achieved good neurological outcome (cerebral-performance-category (CPC) =1 or 2) at 30 days. Successful revascularization by percutaneous coronary intervention (PCI) was not associated with low mortality (P=0.77). Past history of CAD (P=0.014) and high Syntax score (P=0.030) were associated with mortality. Bystander cardiopulmonary resuscitation (CPR) (P-0.021), pre-hospital ROSC (P<0.001) was more frequent in patients with good neurological outcome. Pre-hospital ROSC (OR 14.7; 95% CI 3.1–69.3; P<0.001) was independently predictive for good neurological outcome. Conclusions Successful PCI for OHCA patients with no ST-segment elevation was not a predictor of mortality. CAD past history and complex CAD was associated with mortality. Pre-hospital information such as pre-hospital ROSC was important to achieve good neurological outcome.

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