scholarly journals Diagnostic performance and potential clinical impact of advanced care paramedic interpretation of ST-segment elevation myocardial infarction in the field

CJEM ◽  
2006 ◽  
Vol 8 (06) ◽  
pp. 401-407 ◽  
Author(s):  
Michel R. Le May ◽  
Richard Dionne ◽  
Justin Maloney ◽  
John Trickett ◽  
Irene Watpool ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Thrombolytic Therapy ◽  
Predictive Value ◽  
Correct Diagnosis ◽  
St Segment Elevation ◽  
St Segment ◽  
Integrated Programs ◽  
St Elevation ◽  
Potential Clinical Impact ◽  
Electrocardiogram Ecg

ABSTRACT Objectives: Most studies of pre-hospital management of ST-elevation myocardial infarction (STEMI) have involved physicians accompanying the ambulance crew, or electrocardiogram (ECG) transmission to a physician at the base hospital. We sought to determine if Advanced Care Paramedics (ACPs) could accurately identify STEMI on the pre-hospital ECG and contribute to strategies that shorten time to reperfusion. Methods: A STEMI tool was developed to: 1) measure the accuracy of the ACPs at diagnosing STEMI; and 2) determine the potential time saved if ACPs were to independently administer thrombolytic therapy. Using registry data, we subsequently estimated the time saved by initiating thrombolytic therapy in the field compared with in-hospital administration by a physician. Results: Between August 2003 and July 2004, a correct diagnosis of STEMI on the pre-hospital ECG was confirmed in 63 patients. The performance of the ACPs in identifying STEMI on the ECG resulted in a sensitivity of 95% (95% confidence interval [CI] 86%–99%), a specificity of 96% (95% CI 94%–98%), a positive predictive value (PPV) of 82% (95% CI 71%–90%), and a negative predictive value (NPV) of 99% (95% CI 97%–100%). ACP performance for appropriately using thrombolytic therapy resulted in a sensitivity of 92% (95% CI 78%–98%), a specificity of 97% (95% CI 94%–98%), a PPV of 73% (95% CI 59%–85%) and an NPV of 99% (95% CI 97%–100%). We estimated that the median time saved by ACP administration of thrombolytic therapy would have been 44 minutes. Conclusions: ACPs can be trained to accurately interpret the pre-hospital ECG for the diagnosis of STEMI. These results are important for the design of regional integrated programs aimed at reducing delays to reperfusion.

ST Elevation is not Always Equivalent to Acute Myocardial Infarction: a Case of Brugada Syndrome

2003 ◽  
Vol 10 (2) ◽  
pp. 121-123
Author(s):  
YF Choi ◽  
AYC Siu ◽  
TW Wong ◽  
CC Lau
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Emergency Department ◽  
Thrombolytic Therapy ◽  
Brugada Syndrome ◽  
Diagnostic Tools ◽  
St Segment Elevation ◽  
St Segment ◽  
St Elevation ◽  
Electrocardiogram Ecg

Acute myocardial infarction (AMI) is one of the most alerting situations in emergency department. Electrocardiogram (ECG) is one of the most important diagnostic tools and the decision about thrombolytic therapy is usually based upon ECG findings when clinically suspicious. However, ST segment elevation is not always equivalent to acute myocardial infarction. We present a rare syndrome whose ECG shows persistent ST elevation not related to AMI.

scholarly journals A Comparative Study of St Segment Resolution between Diabetic and Non-Diabetic ST Segment Elevation Myocardial Infarction Patients following Streptokinase Thrombolysis

2019 ◽  
Vol 11 (2) ◽  
pp. 118-122
Author(s):  
Shahriar Iqbal ◽  
M Saiful Bari ◽  
MA Bari ◽  
Mirza Md Nazrul Islam ◽  
M Abdullah Al Shafi Majumder ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Thrombolytic Therapy ◽  
St Elevation Myocardial Infarction ◽  
Diabetic Patients ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
St Elevation ◽  
Prolong Hospital Stay

Background: One of the most effective and used (in our settings) methods of reperfusion of ST elevation myocardial infarction (STEMI) is administration of streptokinase (SK) infusion. This study was conducted with the aim to compare ST segment resolution between diabetic and non-diabetic patients with ST segment elevation myocardial infarction after thrombolysis by streptokinase. Methods: A total of 100 patients with ST elevation myocardial infarction with or without diabetes mellitus were studied from December 2016 to November 2017. Among these half of patients were diabetic while rests were non-diabetic. Streptokinase was administered to all patients. Resolution (reduction) of elevated ST segment was evaluated after 90 min of streptokinase administration. Results: Failed reperfusion (<30% ST resolution) was significantly higher in diabetic as compared to nondiabetic patients (42% vs. 12%, p <0.001). In hospital complications were more in diabetic patients who has failed reperfusion following streptokinase thrombolysis. Cardiogenic shock occurred in 44% and acute LVF in 30% patients and EF (46.54%) was significantly lower in diabetic patients and higher number of diabetic patients had prolong hospital stay than non-diabetic patients with STEMI. Conclusion: The outcome of thrombolytic therapy is adversely affected by diabetes mellitus in patients with ST-elevation myocardial infarction. Cardiovasc. j. 2019; 11(2): 118-122

Implications of ventricular arrhythmia “bursts” with normal epicardial flow, myocardial blush, and ST-segment recovery in anterior ST-elevation myocardial infarction reperfusion: A biosignature of direct myocellular injury “downstream of downstream”

2014 ◽  
Vol 4 (1) ◽  
pp. 51-59 ◽  
Author(s):  
Mohamed Majidi ◽  
Andrzej S Kosinski ◽  
Sana M Al-Khatib ◽  
Lilian Smolders ◽  
Ecaterina Cristea ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ventricular Arrhythmia ◽  
Cellular Response ◽  
Multivariable Analysis ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Electrocardiogram Ecg

Aims: Establishing epicardial flow with percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) is necessary but not sufficient to ensure nutritive myocardial reperfusion. We evaluated whether adding myocardial blush grade (MBG) and quantitative reperfusion ventricular arrhythmia “bursts” (VABs) surrogates provide a more informative biosignature of optimal reperfusion in patients with Thrombolysis in Myocardial Infarction (TIMI) 3 flow and ST-segment recovery (STR). Methods and results: Anterior STEMI patients with final TIMI 3 flow had protocol-blinded analyses of simultaneous MBG, continuous 12-lead electrocardiogram (ECG) STR, Holter VABs, and day 5–14 SPECT imaging infarct size (IS) assessments. Over 20 million cardiac cycles from >4500 h of continuous ECG monitoring in subjects with STR were obtained. IS and clinical outcomes were examined in patients stratified by MBG and VABs. VABs occurred in 51% (79/154) of subjects. Microcirculation (MBG 2/3) was restored in 75% (115/154) of subjects, of whom 53% (61/115) had VABs. No VABs were observed in subjects without microvascular flow (MBG of 0). Of 115 patients with TIMI 3 flow, STR, and MBG 2/3, those with VABs had significantly larger IS (median: 23.0% vs 6.0%, p=0.001). Multivariable analysis identified reperfusion VABs as a factor significantly associated with larger IS ( p=0.015). Conclusions: Despite restoration of normal epicardial flow, open microcirculation, and STR, concomitant VABs are associated with larger myocardial IS, possibly reflecting myocellular injury in reperfusion settings. Combining angiographic and ECG parameters of epicardial, microvascular, and cellular response to STEMI intervention provides a more predictive “biosignature” of optimal reperfusion than do single surrogate markers.

scholarly journals Posterior myocardial infarction with isolated ST elevations in V8 and V9: Is this an “ST elevation MI”?

CJEM ◽  
2003 ◽  
Vol 5 (02) ◽  
pp. 115-118
Author(s):  
Lance Brown ◽  
Jessica Sims ◽  
Alessandra Conforto
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Artery Occlusion ◽  
Primary Angioplasty ◽  
Artery Occlusion ◽  
St Segment Elevation ◽  
St Segment ◽  
St Elevation ◽  
Artery Disease ◽  
Electrocardiogram Ecg

ABSTRACT We report a case of a 53-year-old man whose first manifestation of coronary artery disease was an acute isolated posterior myocardial infarction (IPMI). Acute IPMI is relatively uncommon and predominantly due to occlusion of the left circumflex coronary artery. IPMI is challenging to diagnose due to the absence of ST segment elevation on a standard 12-lead electrocardiogram (ECG) even in the setting of total coronary artery occlusion and transmural (Q-wave) infarct. We discuss the diagnostic implications of the absence of tall R waves in leads V1 and V2 on this patient’s ECG. The utility of posterior leads (V7 through V9) is demonstrated. The controversy surrounding the use of thrombolytic therapy or primary angioplasty in the setting of acute IPMI without ST segment elevation on a standard 12-lead ECG is reviewed.

scholarly journals Efficacy of thrombolytic therapy with IV streptokinase in acute ST elevation myocardial infarction patients

2019 ◽  
Vol 6 (4) ◽  
pp. 1121
Author(s):  
Karthik S. ◽  
Satchi A. Surendran ◽  
Mohamed Kasim A.
Keyword(s):  
Myocardial Infarction ◽  
Adverse Events ◽  
Thrombolytic Therapy ◽  
Term Outcome ◽  
Mortality And Morbidity ◽  
St Segment Elevation ◽  
Acute Stemi ◽  
St Segment ◽  
Causes Of Mortality ◽  
St Elevation

Background: Acute Myocardial Infarction is one of the leading causes of mortality and morbidity. Now there are a number of drugs for Thrombolysis but still Streptokinase is used in many of the centers because of the ease of availability and less cost. ST segment elevation resolution following thrombolysis is simple, non-invasive, accessible tool for the assessment of coronary reperfusion. Objective of the present study was to assess the efficacy of thrombolysis in Acute STEMI patients, with respect to resolution of ST-elevation on treatment with streptokinase and also to predict short term outcome during hospital stay in terms of adverse events and mortality.Methods: 60 Acute STEMI patients who had received thrombolytic therapy with streptokinase were studied in three groups namely Category A, Category B and Category C based on ST segment resolution after administration of thrombolytic therapy.Results: Of 60 patients, 9 patients (15%) had <30% ST resolution (no STR), 26 patients (43.3%) had 30-70% ST resolution (partial STR), 25 patients (41.7%) had >70% ST resolution (complete STR).Conclusions: In the present study we conclude that the efficacy of IV streptokinase for thrombolysis in acute STEMI is 41.7%. Patients with no resolution of ST segment 90 minutes following thrombolysis associated with more frequent adverse events and increased mortality compare to partial and complete resolution group.

scholarly journals Management of ST Elevation Myocardial Infarction (STEMI) in Different Settings

2021 ◽  
Author(s):  
Rod Partow-Navid ◽  
Narut Prasitlumkum ◽  
Ashish Mukherjee ◽  
Padmini Varadarajan ◽  
Ramdas G. Pai
Keyword(s):  
Myocardial Infarction ◽  
Treatment Strategies ◽  
Management Process ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Multiple Factors ◽  
St Segment ◽  
Threatening Condition ◽  
Life Threatening ◽  
St Elevation

AbstractST-segment elevation myocardial infarction (STEMI) is a life-threatening condition that requires emergent, complex, well-coordinated treatment. Although the primary goal of treatment is simple to describe—reperfusion as quickly as possible—the management process is complicated and is affected by multiple factors including location, patient, and practitioner characteristics. Hence, this narrative review will discuss the recommended management and treatment strategies of STEMI in the circumstances.

Abstract 12762: Clinical Characteristics and Determinants of Non-Eligibility for Reperfusion in Patients With ST Segment Elevation Myocardial Infarction: Insights From the NCDR®

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Tarun W Dasari ◽  
Steve Hamilton ◽  
Anita Y Chen ◽  
Tracy Y Wang ◽  
James A de Lemos ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Characteristics ◽  
Major Contributor ◽  
Primary Pci ◽  
Hospital Outcomes ◽  
St Segment Elevation ◽  
Vessel Disease ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
St Elevation

Background: There is little recent data describing the characteristics and outcomes of STEMI patients who do not undergo urgent reperfusion. Methods: Using the ACTION Registry®-GWTG™ database, we examined 232,208 STEMI patients presenting January 2007 through December 2013 at 793 U.S. centers. The cohort was divided into those who underwent reperfusion (n=194,916; 84%), had documented contraindication to reperfusion (n=31,518; 13.5%) and were eligible but not reperfused (n=5,774; 2.5%). Clinical characteristics and in-hospital outcomes were compared between these groups. Results: Compared with those reperfused, patients not reperfused were older, more often female and had higher rates of hypertension, diabetes, MI, stroke and atrial fibrillation. LBBB and CHF were more common in the non-reperfused groups upon presentation. The major documented contraindications to reperfusion were unsuitable anatomy for primary PCI (31%), symptoms onset > 12 hours (9%), patient/family refusal/DNR status (6%), resolved chest pain (6%) and ST elevation (5%) presentation to non-PCI centers (4%). Three-vessel disease and in-hospital CABG were more common in non-reperfused patients with and without contraindication compared with those receiving reperfusion (39 & 37% vs. 26%, p<0.001) and (17 & 17% vs. 3%, p<0.001 respectively). In-hospital outcomes are summarized in the table. Conclusion: Most STEMI patients who were not reperfused had a documented contraindication. Unsuitable anatomy for PCI was the major contributor to ineligibility. In hospital mortality, death/MI and cardiogenic shock were higher in the non-reperfused groups.

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