The association between pre-infarction angina and care-seeking behaviors and its effects on early reperfusion rates for acute myocardial infarction

SummaryPreinfarction angina and early reperfusion of the infarct-related artery are major determinants of reduced infarct-size in patients with acute myocardial infarction. The beneficial effects of preinfarction angina on infarct size have been attributed to the development of collateral vessels and/or to post-ischemic myocardial protection. However, recently, a relation has been found between prodromal angina, faster coronary recanalization, and smaller infarcts in patients treated with rt-PA: those with preinfarction angina showed earlier reperfusion (p = 0.006) and a 50% reduction of CKMB-estimated infarct-size (p = 0.009) compared to patients without preinfarction angina. This intriguing observation is consistent with a subsequent observation of higher coronary recanalization rates following thrombolysis in patients with prodromal preinfarction angina compared to patients without antecedent angina. Recent findings in dogs show an enhanced spontaneous lysis of plateletrich coronary thrombi with ischemic preconditioning, which is prevented by adenosine blockade, suggesting an antithrom-botic effect of ischemic metabolites. Understanding the mechanisms responsible for earlier and enhanced coronary recanalization in patients with preinfarction angina may open the way to new reperfusion strategies.A vast number of studies, globally involving ≈17,000 patients with acute myocardial infarction, have unequivocally shown that an infarction preceded by angina evolves into a smaller area of necrosis compared to an infarct not preceded by angina (Table 1) (1). So far, preinfarction angina has been thought to have cardioprotective effects mainly through two mechanisms: collateral perfusion of the infarctzone (2-4), and ischemic preconditioning of the myocardium (5-7). Here we discuss a further mechanism of protection represented by improved reperfusion of the infarct-related artery.

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Early Reperfusion Assessment and Repeated Thrombolysis in Acute Myocardial Infarction Estimated by Repeated Standard Electrocardiography

Cardiology ◽

10.1159/000007047 ◽

2000 ◽

Vol 94 (1) ◽

pp. 58-65 ◽

Cited By ~ 5

Author(s):

Sabine Gill ◽

Benedikte Haastrup ◽

Torben Haghfelt ◽

Mikael Dellborg ◽

Peter M. Clemmensen

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Early Reperfusion

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Thrombolysis related early reperfusion reduces ECG late potentials after acute myocardial infarction

Journal of the American College of Cardiology ◽

10.1016/0735-1097(91)92214-7 ◽

1991 ◽

Vol 17 (2) ◽

pp. A312 ◽

Cited By ~ 1

Author(s):

Fidela Moreno ◽

Labros Karagounis ◽

Steven Ipsen ◽

Hiram Marshall ◽

Jeffrey L. Anderson

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Late Potentials ◽

Early Reperfusion

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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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Predictors of pre-hospital delay in Hong Kong Chinese patients with acute myocardial infarction

European Journal of Cardiovascular Nursing ◽

10.1177/1474515117718914 ◽

2017 ◽

Vol 17 (1) ◽

pp. 75-84 ◽

Cited By ~ 4

Author(s):

Polly WC Li ◽

Doris SF Yu

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hong Kong ◽

Barriers To Care ◽

Female Gender ◽

Perceived Barriers ◽

Hong Kong Chinese ◽

Chinese Patients ◽

Care Seeking ◽

Symptom Presentation

Background: The pre-hospital delay to seek care remains the most significant barrier for effective management of acute myocardial infarction. Many of the previous studies mainly took place in Western countries. Few data are available about the care-seeking behavior of Hong Kong Chinese. Aim: The purpose of this study was to identify the predictors of pre-hospital delay in care seeking among Hong Kong Chinese patients with acute myocardial infarction. Methods: Adult Chinese patients ( n=301) with a confirmed diagnosis of acute myocardial infarction were recruited from the cardiac units of three regional hospitals in Hong Kong. Various socio-demographic, clinical, symptom presentation characteristics and patient perceptual factors were considered as potential predictors. Multivariate analysis was conducted to identify the independent predictors with pre-hospital delay in care-seeking among acute myocardial infarction patients. Results: Perceived barriers to care seeking constituted the most significant predictor for longer pre-hospital delay in acute myocardial infarction patients. Female gender was also significant in predicting longer delay, whereas a greater extent of symptom congruence and a greater extent of typical symptom presentation were significantly associated with a shorter delay. The final model accounted for 49.6% of the variance in pre-hospital delay as a whole. Conclusion: The most prominent predictors of pre-hospital delay are modifiable in nature, including the perceived barriers to care seeking and symptom congruence. Other sociodemographic and clinical factors also influence patients’ decision. Although these are non-modifiable, our findings provide important insight for educating high-risk individuals.

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S100a8/a9 Signaling Causes Mitochondrial Dysfunction and Cardiomyocyte Death in Response to Ischemic/Reperfusion Injury

Circulation ◽

10.1161/circulationaha.118.039262 ◽

2019 ◽

Vol 140 (9) ◽

pp. 751-764 ◽

Cited By ~ 20

Author(s):

Yulin Li ◽

Boya Chen ◽

Xinying Yang ◽

Congcong Zhang ◽

Yao Jiao ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Cardiovascular Events ◽

Ischemia Reperfusion ◽

Coronary Intervention ◽

Major Adverse Cardiovascular Events ◽

Mouse Heart ◽

Early Reperfusion ◽

Percutaneous Coronary

Background: Myocardial ischemia-reperfusion (MI/R) injury is a significant clinical problem without effective therapy. Unbiased omics approaches may reveal key MI/R mediators to initiate MI/R injury. Methods: We used a dynamic transcriptome analysis of mouse heart exposed to various MI/R periods to identify S100a8/a9 as an early mediator. Using loss/gain-of-function approaches to understand the role of S100a8/a9 in MI/R injury, we explored the mechanisms through transcriptome and functional experiment. Dynamic serum S100a8/a9 levels were measured in patients with acute myocardial infarction before and after percutaneous coronary intervention. Patients were prospectively followed for the occurrence of major adverse cardiovascular events. Results: S100a8/a9 was identified as the most significantly upregulated gene during the early reperfusion stage. Knockout of S100a9 markedly decreased cardiomyocyte death and improved heart function, whereas hematopoietic overexpression of S100a9 exacerbated MI/R injury. Transcriptome/functional studies revealed that S100a8/a9 caused mitochondrial respiratory dysfunction in cardiomyocytes. Mechanistically, S100a8/a9 downregulated NDUF gene expression with subsequent mitochondrial complex I inhibition via Toll-like receptor 4/Erk–mediated Pparg coactivator 1 alpha/nuclear respiratory factor 1 signaling suppression. Administration of S100a9 neutralizing antibody significantly reduced MI/R injury and improved cardiac function. Finally, we demonstrated that serum S100a8/a9 levels were significantly increased 1 day after percutaneous coronary intervention in patients with acute myocardial infarction, and elevated S100a8/a9 levels were associated with the incidence of major adverse cardiovascular events. Conclusions: Our study identified S100a8/a9 as a master regulator causing cardiomyocyte death in the early stage of MI/R injury via the suppression of mitochondrial function. Targeting S100a8/a9-intiated signaling may represent a novel therapeutic intervention against MI/R injury. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03752515

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Conservative Management of Subacute Contained Left Ventricular Rupture after Acute Myocardial Infarction

Indian Journal of Cardiovascular Disease in Women WINCARS ◽

10.1055/s-0038-1669784 ◽

2018 ◽

Vol 03 (01) ◽

pp. 034-038

Author(s):

Bharat Goud C ◽

Johann Christopher

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Color Doppler ◽

Regional Wall Motion ◽

Left Ventricular ◽

Mechanical Complication ◽

Inferior Wall ◽

Early Reperfusion ◽

St Segment Elevation ◽

Myocardial Wall

AbstractLeft ventricular free wall rupture (LVFWR) is a near-fatal mechanical complication of acute myocardial infarction in which an early diagnosis and emergency surgery should be of utmost priority for successful treatment. LVFWR is generally perceived to be universally fatal. Majority of LVFWR patients developing cardiac tamponade die rapidly, while in minority of cases the development of tamponade may be sufficiently slow to allow for diagnosis and successful intervention. In this article, the authors report a case of a 63-year-old male patient diagnosed with an inferoposterior wall myocardial infarction treated with early reperfusion thrombolytic therapy presenting 3 days later with diagnosis of subacute LVFWR. Patient had a history of relapse of chest pain which was severe and prolonged with 2 to 3 mm saddle-shaped ST-segment elevation in lateral leads, detected on a routine electrocardiogram, which led to an urgent bedside transthoracic echocardiogram (TTE). TTE showed regional wall motion abnormality in form of akinetic basal inferior-wall, a small echodense pericardial effusion, and a canalicular tract from endocardium to pericardium, through which color-Doppler examination suggested blood crossing the myocardial wall. A cardiac magnetic resonance imaging further reinforced the possibility of contained LVFWR.

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Inability to act was associated with an extended delay prior to care-seeking, in patients with an acute myocardial infarction

European Journal of Cardiovascular Nursing ◽

10.1177/1474515119844654 ◽

2019 ◽

Vol 18 (6) ◽

pp. 512-520 ◽

Cited By ~ 2

Author(s):

Carolin Nymark ◽

Peter Henriksson ◽

Anne-Cathrine Mattiasson ◽

Fredrik Saboonchi ◽

Anna Kiessling

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Medical Care ◽

Patient Delay ◽

Care Seeking ◽

Projection To Latent Structures ◽

Symptom Appraisal ◽

Latent Structures ◽

Appraisal Processes ◽

Main Influence

Background:The out-of-hospital mortality in patients with acute myocardial infarction remains unchanged in contrast to a decrease in inhospital mortality. Interventions aiming to shorten patient delay have been largely unsuccessful. A deeper understanding is apparently needed on patients’ appraisal prior to care-seeking.Aim:To investigate whether appraisal processes influence patient delay, and if the questionnaire ‘Patients’ appraisal, emotions and action tendencies preceding care seeking in acute myocardial infarction’ (PA-AMI) could discriminate between patients with prolonged care-seeking and those with a short delay.Methods:A cross-sectional study including 326 acute myocardial infarction patients filling out the validated questionnaire PA-AMI. The impact of subscales on delay was analysed by projection to latent structures regression. Discrimination opportunities between patients with short and long delays were analysed by projection to latent structures discriminant analysis.Results:The subscales ‘perceived inability to act’ and ‘symptom appraisal’ had a major impact on patient delay ( P<0.0001). ‘Perceived inability to act’ had its main influence in patients with a delay exceeding 12 hours, and ‘symptom appraisal’ had its main influence in patients with a delay shorter than one hour.Conclusion:Appraisal processes influence patient delay. Acute myocardial infarction patients with a prolonged delay were, besides a low perceived symptom severity and urgency to seek medical care, characterised by a perceived loss of control and ability to act. Therefore, future interventions aimed at decreasing delay should pay attention to appraisal processes, and perceived inability to act may be a sign of a health threat and therefore a signal to seek medical care.

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Serum Levels of Vascular Endothelial Growth Factor in Patients with Acute Myocardial Infarction Undergoing Reperfusion Therapy

Clinical Science ◽

10.1042/cs0920453 ◽

1997 ◽

Vol 92 (5) ◽

pp. 453-454 ◽

Cited By ~ 54

Author(s):

Yoshinori Seko ◽

Yasushi Imai ◽

Shin Suzuki ◽

Shuichi Kamijukkoku ◽

Kazuya Hayasaki ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Vascular Endothelial Growth Factor ◽

Growth Factor ◽

Serum Levels ◽

Reperfusion Therapy ◽

Vascular Endothelial ◽

Early Reperfusion ◽

Healthy Control ◽

Endothelial Growth Factor

1. Vascular endothelial growth factor, a potent angiogenic mitogen, is known to be induced in response to ischaemia as well as being secreted from tumour cells. However, the precise mechanism of vascular endothelial growth factor release in acute myocardial infarction and the effects of coronary reperfusion on the circulating levels of vascular endothelial growth factor are still unknown. 2. Nineteen patients with acute myocardial infarction who underwent early reperfusion therapy were studied. Serum levels of vascular endothelial growth factor before reperfusion were markedly increased as compared with those in 19 healthy control subjects [252.4 ± 158.1 pg/ml (mean ± SD) compared with undetectable]. After reperfusion, the serum vascular endothelial growth factor levels rapidly returned almost completely to the normal control range. 4. These data strongly suggest that the serum level of vascular endothelial growth factor is one of the most sensitive indicators of myocardial ischaemia.

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