Clot formation and endogenous fibrinolysis in acs patients compared to patients with a history of st elevation myocardial infarction

2020 ◽  
Vol 315 ◽  
pp. e233
Author(s):  
O.A. Dukhin ◽  
A. Kalinskaya ◽  
H. Uzhakhova ◽  
E. Vasilieva ◽  
A. Shpektor
Keyword(s):  
Myocardial Infarction ◽  
St Elevation Myocardial Infarction ◽  
Clot Formation ◽  
History Of ◽  
St Elevation ◽  
Endogenous Fibrinolysis

Factors influencing patient decision delay in activation of emergency medical services for suspected ST-elevation myocardial infarction

2020 ◽  
pp. 147451512095373
Author(s):  
Ahmad Alrawashdeh ◽  
Ziad Nehme ◽  
Brett Williams ◽  
Karen Smith ◽  
Michael Stephenson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Emergency Medical Services ◽  
Symptom Onset ◽  
St Elevation Myocardial Infarction ◽  
Medical Services ◽  
Factors Associated ◽  
Emergency Medical ◽  
History Of ◽  
St Elevation ◽  
At Home

Objective: The purpose of this study was to identify factors associated with time delay to emergency medical services for patients with suspected ST-elevation myocardial infarction. Methods: This observational study involved 1994 suspected ST-elevation myocardial infarction patients presenting to the emergency medical services in Melbourne, Australia, between October 2011–January 2014. Factors associated with delays to emergency medical services call of >1 h and emergency medical services self-referral were analyzed using multivariable logistic regression. Results: The time of symptom onset was reported for 1819 patients (91.2%), the median symptom onset-to-call time was 52 min (interquartile range=17–176). Of all emergency medical services calls, 17% were referred by healthcare professionals. Compared to self-referred patients, patients who presented to a general practitioner or hospital had higher odds of delay >1 h to emergency medical services activation (adjusted odds ratio 7.76; 95% confidence interval 5.10–11.83; and 8.02; 3.65–17.64, respectively). The other factors associated with emergency medical services call delays of >1 h were living alone, non-English speaking background, a history of substance abuse, less severe symptoms, symptom onset at home and at rest, and self-treatment. Emergency medical services self-referred patients were more likely to be older than 75 years, have a history of ischemic heart disease or revascularization, more severe symptoms, and symptom onset at home, with activity, during the weekends and out-of-hours. Conclusion: Almost one-fifth of emergency medical services calls for suspected ST-elevation myocardial infarction were healthcare referrals, and this was associated with increased delays. A wide range of factors could influence a patient’s decision to directly and rapidly seek emergency medical services. More efforts are needed to educate at-risk populations about early self-referral to the emergency medical services.

scholarly journals Ramipril and Losartan Exert a Similar Long-Term Effect upon Markers of Heart Failure, Endogenous Fibrinolysis, and Platelet Aggregation in Survivors of ST-Elevation Myocardial Infarction: A Single Centre Randomized Trial

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Martin Marinšek ◽  
Andreja Sinkovič
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Platelet Aggregation ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Control Group ◽  
St Elevation ◽  
Pai 1 ◽  
Endogenous Fibrinolysis

Introduction. Blocking the renin-angiotensin-aldosterone system in ST-elevation myocardial infarction (STEMI) patients prevents heart failure and recurrent thrombosis. Our aim was to compare the effects of ramipril and losartan upon the markers of heart failure, endogenous fibrinolysis, and platelet aggregation in STEMI patients over the long term.Methods. After primary percutaneous coronary intervention (PPCI), 28 STEMI patients were randomly assigned ramipril and 27 losartan, receiving therapy for six months with dual antiplatelet therapy (DAPT). We measured N-terminal proBNP (NT-proBNP), ejection fraction (EF), plasminogen-activator-inhibitor type 1 (PAI-1), and platelet aggregation by closure times (CT) at the baseline and after six months.Results. Baseline NT-proBNP ≥ 200 pmol/mL was observed in 48.1% of the patients, EF < 55% in 49.1%, and PAI-1 ≥ 3.5 U/mL in 32.7%. Six-month treatment with ramipril or losartan resulted in a similar effect upon PAI-1, NT-proBNP, EF, and CT levels in survivors of STEMI, but in comparison to control group, receiving DAPT alone, ramipril or losartan treatment with DAPT significantly increased mean CT (226.7 ± 80.3 sec versus 158.1 ± 80.3 sec,p<0.05).Conclusions. Ramipril and losartan exert a similar effect upon markers of heart failure and endogenous fibrinolysis, and, with DAPT, a more efficient antiplatelet effect in long term than DAPT alone.

P6529Safety of emergency pretreatment regimen for contrast allergy before percutaneous coronary intervention for ST-elevation myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Jha ◽  
A Berger ◽  
J Blankenship
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Medical Center ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Prior History ◽  
Percutaneous Coronary ◽  
History Of ◽  
St Elevation ◽  
Contrast Allergy

Abstract Background Primary percutaneous coronary intervention (PPCI) is the best treatment for ST-elevation myocardial infarction (STEMI). However, patients with prior contrast reactions may not receive PCI due to concern over a recurrent contrast reaction. Purpose To determine the clinical efficacy of emergency pretreatment regimens for contrast allergy in STEMI patients undergoing PPCI. Methods We retrospectively identified all individuals with a history of contrast allergy who presented with STEMI, were pretreated for contrast allergy, and underwent PPCI at our medical center between January 2005 to May 2018. Emergency pretreatment regimen included a combination of intravenous (IV) steroid, IV famotidine and IV diphenhydramine administered immediately before PCI. Laboratory records, inpatient notes, and discharge summaries were reviewed to confirm the severity of the original contrast allergy and identify any allergic breakthrough reaction after pretreatment with an emergency regimen. Reactions were characterized as mild, moderate, severe, or of unknown severity. Results During the study period 15,712 individuals underwent PCI, of which 176 patients presented with STEMI, had confirmed contrast allergy, and were pretreated before undergoing PCI. No patient with a history of contrast allergy underwent PPCI without pre-treatment. Mean age was 64 years, with 52% males, and all individuals were white. The majority had hypertension (77%), 67% had dyslipidemia, 29% had diabetes mellitus, and 20% patients had a prior history of MI. Intravenous steroids used in the emergency regimen included methylprednisone (n=100), hydrocortisone (n=70), and dexamethasone (n=6). The original allergic response to ICM was mild in 59% patients, moderate in 15%, severe in 20% and of unknown severity in 13% patients. Of the 176 patients only 10 (5.6%) developed a breakthrough reaction. Most of which were mild; none was fatal. Median length of hospital stays was three days and nine patients (10.8%) passed away within 30 days of hospital admission. Conclusions Patients with prior contrast allergy presenting with STEMI can safely undergo PPCI after emergency pretreatment. Breakthrough reactions are infrequent and mild.

Abstract 337: Prognostic Impact of Cardiac Arrest Among Patients With ST-Elevation Myocardial Infarction

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Anirudh Kumar ◽  
Chetan P Huded ◽  
Michael J Johnson ◽  
Venu Menon ◽  
Stephen G Ellis ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiac Arrest ◽  
Troponin T ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Prognostic Impact ◽  
History Of ◽  
St Elevation ◽  
The Impact

Background: ST-elevation myocardial infarction (STEMI) is a potentially fatal condition that may be complicated by cardiac arrest (CA). However, the impact of CA complicating STEMI on prognosis in the contemporary era of rapid primary PCI is uncertain. Methods: We reviewed consecutive cases of STEMI treated with percutaneous coronary intervention (PCI) at our center between January 1, 2011 and December 31, 2016. Baseline clinical characteristics and in-hospital long-term outcomes were compared between patients with and without CA. Results: Among 1,272 patients with STEMI, 148 (11.6%) had CA (30.4% out-of-hospital, 69.6% after ED arrival). Compared to patients without CA, patients with STEMI+CA were more likely to have a history of heart failure, valve surgery, peripheral and cerebrovascular disease, and chronic kidney disease with a trend towards increased prevalence of left main or left anterior descending culprit vessel. Patients with STEMI+CA had greater creatinine (1.28±0.92 vs. 1.07±0.67, p=0.013, infarct size (CK-MB 171.6±131.6 vs. 139.2±117.0 ng/mL, p=0.010; troponin T 6.2±6.2 vs. 5.0±4.8 ng/mL, p=0.024), door-to-balloon-time (118.1±63.6 vs. 106.8±64.0, p=0.045), and incidence of cardiogenic shock (48.0% vs. 5.9%, p<0.0001) and intra-aortic balloon pump need (36.5% vs. 8.3%, p<0.0001). Patients with STEMI+ CA had higher rates of major bleeding (25.0% vs. 9.4%, p<0.0001) and post-PCI heart failure (13.5% vs. 8.1%, p=0.042). Patients with STEMI+CA had significantly greater mortality in-hospital (14.9% vs. 3.6%, p<0.0001) and at 1-year (22.9% vs. 9.3%, p<0.0001) (Figure). Conclusions: CA is a complication in >1 in 10 patients with STEMI and is associated with significantly higher morbidity and mortality compared with STEMI without CA. Strategies to improve the care and outcomes of STEMI patients with CA are needed.

scholarly journals Acute Myocardial Infarction in Snake bite Envenomation – A Case Report

2015 ◽  
Vol 16 (1) ◽  
pp. 46-47
Author(s):  
NS Neki
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Case Report ◽  
Chest Pain ◽  
Rare Complication ◽  
Snake Bite ◽  
St Elevation Myocardial Infarction ◽  
History Of ◽  
Electrocardiographic Changes ◽  
St Elevation

Snake bite envenomation is a common problem in tropical countries, especially in rural parts of India. We came across a 30 year old male who presented to the hospital after 4 hours with history of Russell’s viper snake bite developing acute non ST elevation myocardial infarction (MI). Myocardial infarction was confirmed by history of left sided chest pain radiating to left arm with diaphoresis and electrocardiographic changes with increased serum troponin levels. Myocardial infarction is a rare complication of snake bite hence case report.DOI: http://dx.doi.org/10.3329/jom.v16i1.22401 J MEDICINE 2015; 16 : 46-47

scholarly journals Short and long term prognosis of patients with myocardial infarction. Hungarian Myocardial Infarction Registry

2013 ◽  
Vol 154 (33) ◽  
pp. 1297-1302 ◽  
Author(s):  
András Jánosi ◽  
Péter Ofner ◽  
Béla Merkely ◽  
Péter Polgár ◽  
Károly Zámolyi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Mortality Data ◽  
Killip Class ◽  
History Of ◽  
Short And Long Term ◽  
St Elevation ◽  
The Difference ◽  
Long Term Prognosis

Introduction: Mortality data of patients with acute myocardial infarction are incomplete in Hungary. Aim: The aim of the authors was to analyse the data of 8582 myocardial infarction patients (4981 with ST-elevation myocardial infarction) registered in the Hungarian Myocardial Infarction Register in order to define the hospital, 30-day, and 1-year mortality. To evaluate the prehospital mortality of myocardial infarction, all myocardial infarction and sudden death were registered in five districts of Budapest. Method: Multivariate logistic regression was performed to define risk factors of mortality and the model were assessed using c statistics. Results: The hospital, 30-day and 1-year mortality of patients with ST elevation myocardial infarction were 3.7%, 9.5% and 16.5%, respectively. In patients without ST elevation myocardial infarction these figures were 4%, 9.8% and 21.7%, respectively. The 1-year mortality of patients without ST elevation was higher than those of with ST elevation and the difference was statistically significant. Age, Killip class, diabetes mellitus, history of stroke and myocardial infarction were independent predictors of death. Coronary intervention improved the prognosis of patients with myocardial infarction significantly. Conclusions: The rate of pre-hospital mortality was considerably high; 72.5% of 30 day mortality occurred before admission to hospital. Orv. Hetil., 2013, 154, 1297–1302.

scholarly journals Clinical and anamnestic characteristics of patients with non-ST elevation myocardial infarction after COVID-19

2021 ◽  
Vol 20 (7) ◽  
pp. 3062
Author(s):  
M. G. Chashchin ◽  
A. Yu. Gorshkov ◽  
O. M. Drapkina ◽  
I. V. Kositsyna ◽  
A. V. Golubev ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Troponin I ◽  
St Elevation Myocardial Infarction ◽  
Control Group ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Exertional Angina ◽  
History Of ◽  
St Elevation ◽  
Experimental Group

Aim. To study clinical, medical history and paraclinical characteristics of patients with non-ST elevation myocardial infarction (NSTEMI) after coronavirus disease 2019 (COVID-19).Material and methods. The study included 209 patients with NSTEMI who were admitted to the Demikhov City Clinical Hospital (Moscow). The patients were divided into 2 groups: the experimental one (n=104)  — those after COVID-19, the control one (n=105)  — those without history of COVID-19. All patients underwent routine diagnostic investigations in accordance with current standards and clinical guidelines.Results. The mean age of patients in the experimental group was 61,8±12,2 years, while in the control one — 69,0±13,0 years (p<0,0001). Myocardial infarction developed 49 days [34.0; 82.0] after COVID-19. Prior exertional angina was observed in 76,9% of patients in the experimental group and in 88,6% in the control one (χ2 =4,97; p=0,0258). The level of C-reactive protein in the experimental group was 19,2 mg/l [4,9; 53,0], and in the control one — 5,6 mg/l [0,4; 21,8] (p=0,0007). The average troponin I level in the experimental group was 2,7 ng/ml [1,3; 8,0], while in the control one — 1,8 ng/ml [0,8; 3,5] (p=0,0091).Conclusion. Patients with NSTEMI after COVID-19 were significantly younger compared to patients without a history of COVID-19. They had less common exertional angina prior to MI, while C-reactive protein and troponin I levels were significantly higher than in the control group. In addition, in NSTEMI patients after COVID-19, the estimated pulmonary artery systolic pressure was significantly higher compared to patients without a history of COVID-19.

scholarly journals Romanian Patients Who Experience in-Stent Restenosis After St-Elevation Myocardial Infarction: The Experience of a Tertiary Center

2021 ◽  
Vol 18 (2) ◽  
pp. 7-13
Author(s):  
Alice Elena Munteanu ◽  
Liviu Chiriac ◽  
Filip Romi Bolohan ◽  
Daniel Niţă ◽  
Ruxandra Constantinescu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Artery ◽  
St Elevation Myocardial Infarction ◽  
Warning Sign ◽  
Stent Restenosis ◽  
Tertiary Center ◽  
History Of ◽  
St Elevation ◽  
In Stent Restenosis

Abstract Background and aim. Coronary artery disease (CAD) is one of the most important causes of death worldwide. ST-elevation myocardial infarction (STEMI) is an acute form of presentation in patients with CAD. Percutaneous coronary intervention (PCI) is the treatment of choice in STEMI patients. Generally, a stent is placed after the culprit lesion is dilated in order to ensure the patency of the coronary artery. In-stent restenosis (ISR) is a possible chronic complication in this setting. The following study is one of the few of its kind, since it investigates ISR in a cohort of Romanian patients who underwent PCI in the setting of STEMI. Our current descriptive study aims at highlighting the characteristics of these patients and identifying potential risk factors in this specific population, which could be validated by a further larger study. Methods. We studied 68 patients from “Dr. Carol Davila” Central Military Emergency University Hospital in Bucharest, Romania, who presented with STEMI in 2016. The mean time for angiographic reevaluation was 111 days. Results. 94% (64) of the patients underwent primary PCI, while in 6% (4) of the cases thrombolysis was initially attempted before PCI. The most prevalent risk factors that we identified were: arterial hypertension (61%), dyslipidemia (60%) and smoking or history of smoking (47%). The anterior myocardial infarction was the most prevalent (49%). Only 6% of the patients had a documented history of CAD, while on the other hand chronic occlusions were observed in most patients (85%). Of note is that only 11% of the patients reported recurrent angina before the angiographic reevaluation. Conclusion. Common cardiovascular risk factors are also involved in ISR. Their poor management in the case of Romanian patients with STEMI increases the risk of ISR. The lack of symptoms in patients with ISR constitutes a warning sign for clinicians and shows that ISR is a complication which can be easily omitted. Therefore, its incidence is probably underestimated.

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