REDUCTION OF EARLY MORTALITY AND OF CARDIAC RUPTURE IN ACUTE TRANSMURAL MYOCARDIAL INFARCTION BY INTRAVENOUS STREPTOKINASE

1987 ◽  
Author(s):  
J Figueras ◽  
J Cortadellas ◽  
Y Monasterio
Keyword(s):  
Hospital Mortality ◽  
Coronary Arteriography ◽  
Left Ventricular ◽  
Early Mortality ◽  
Cardiac Rupture ◽  
St Segment Elevation ◽  
Reinfarction Rate ◽  
Group I ◽  
St Segment ◽  
Reliable Marker

Patients (Pts)≤ 70 years old with a first transmural AMI of ≤ 4h (164±55 min) were randomized to receive (Group I,GI n=105) or not (GII, n=102) i.v. streptokinase (SK, 840.000U in lh).Contrc ST segment elevation and at lh and 24h after admission were comparable in both groups. Coronary arteriography performed within 15 days showed a recanalization rate of 64% in GI and of 27% in GII (p<0.001)but an incidence of severe stenosis (≥90<100%) higher in GI (46 vs 22%, p<0.01).Recanalized Pts presented an earlier peak of MB creatin kinase in GI (12 vs 16h p<0.01) as well as in GII (15 vs 21h, p<0.002). The incidence of pericarditis was lower in GI (14 vs 35%, p<0.001). Although hospital mortality was comparable in the 2 groups (GI,8% vs GII,11%), early mortality, <5 days, was lower in GI (2 vs 10%, p<0.02). Sudden electromechanical dissociation was the mechanism of death in 12% of patients from GI and in 77% of those from GII and it was associated with left ventricular free wall rupture in each of the 5 autopsied cases but in none of the 5 autopsied cases who died without electromechanical dissociation During a follow-up of 20±11 months (1-36) , mortality an incidence of angina was similar in both groups but reinfarction rate was higher in GI (16 vs 1%, p<0.05).It is concluded that: 1) In contrast with the changes in ST .segment, an early MB creatin kinase peak is a reliable marker of reperfusion; 2) i.v. SK lowers the incidence of pericarditis and of early mortality reducing the incidence of cardiac rupture; and 3) It is conceivable that early treatment of critical residual stenosis will reduce in hospital mortality and reinfarction in these Pts.

scholarly journals Cardiac Rupture—The Most Serious Complication of Takotsubo Syndrome: A Series of Five Cases and a Systematic Review

2021 ◽  
Vol 10 (5) ◽  
pp. 1066
Author(s):  
Małgorzata Zalewska-Adamiec ◽  
Hanna Bachórzewska-Gajewska ◽  
Sławomir Dobrzycki
Keyword(s):  
Female Gender ◽  
Left Ventricular ◽  
Cardiac Rupture ◽  
Control Group ◽  
Mechanical Complication ◽  
Takotsubo Syndrome ◽  
St Segment Elevation ◽  
Glucose Levels ◽  
Risk Of Death ◽  
St Segment

Background: The most serious complication of the acute Takotsubo phase is a myocardial perforation, which is rare, but it usually results in the death of the patient. Methods: In the years 2008–2020, 265 patients were added to the Podlasie Takotsubo Registry. Cardiac rupture was observed in five patients (1.89%), referred to as the Takotsubo syndrome with complications of cardiac rupture (TS+CR) group. The control group consisted of 50 consecutive patients with uncomplicated TS. The diagnosis of TS was based on the Mayo Clinic Criteria. Results: Cardiac rupture was observed in women with TS aged 74–88 years. Patients with TS and CR were older (82.20 vs. 64.84; p = 0.011), than the control group, and had higher troponin, creatine kinase, aspartate aminotransferase, and blood glucose levels (168.40 vs. 120.67; p = 0.010). The TS+CR group demonstrated a higher heart rate (95.75 vs. 68.38; p < 0.0001) and the Global Registry of Acute Coronary Events (GRACE) scores (186.20 vs. 121.24; p < 0.0001) than the control group. In patients with CR, ST segment elevation was recorded significantly more often in the III, V4, V5 and V6 leads. Left ventricular free wall rupture was noted in four patients, and in one case, rupture of the ventricular septum. In a multivariate logistic regression, the factors that increase the risk of CR in TS were high GRACE scores, and the presence of ST segment elevation in lead III. Conclusions: Cardiac rupture in TS is rare but is the most severe mechanical complication and is associated with a very high risk of death. The main risk factors for left ventricular perforation are female gender, older age, a higher concentration of cardiac enzymes, higher GRACE scores, and ST elevations shown using electrocardiogram (ECG).

scholarly journals Risk Factors for Hospital Mortality in Acute ST-Segment Elevation Coronary Syndrome Complicated by Cardiogenic Shock

2021 ◽  
Vol 11 (4) ◽  
pp. 264-270
Author(s):  
O. V. Arsenicheva
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Group I ◽  
Group Ii

The aim. To study the risk factors for hospital mortality in patients with acute coronary syndrome with ST-segment elevation (STEACS) complicated by cardiogenic shock (CS).Materials and methods. A total of 104 patients with STEACS complicated by CS were studied. The follow-up group (group I) included 58 (55,8%) patients who died in hospital (mean age 71,8±7,31 years), the comparison group (group II) – 46 patients, who have been treated and discharged (mean age 59,5±6,18 years). All patients underwent general clinical studies, the level of troponins, lipids, glucose, creatinine in plasma was determined, electrocardiography and echocardiography were performed. Coronary angiography and percutaneous coronary intervention (PCI) were urgently performed. The method of binary logistic regression with the determination of the odds ratio and its 95% confidence interval for each reliable variable was used to identify risk factors for hospital mortality.Results. In group I patients with CS, compared with group II, patients over the age of 70 (32 (55,2%) vs 10 (22,7%), р=0,0004), with concomitant chronic kidney disease (32 (55,2%) vs 9 (19,6%), p=0,0002), postinfarction cardiosclerosis (30 (51,7%) vs 9 (19,6%), р=0,001) and chronic heart failure of III-IV functional class (32 (55,1%) vs 11 (23,9%), p=0,001) were significantly more often observed. Baseline levels of plasma leukocytes, troponin and creatinine were significantly higher in deceased patients with CS. Left ventricular ejection fraction below 40% was observed more often in the follow-up group than in the comparison group (46 (79,3%) vs 27 (58,7%), p=0,022). In group I, compared with group II, there was a higher incidence of three-vessel coronary lesions (36 (75%) vs 12 (26,1%), p=0,0001) and chronic coronary artery occlusion unrelated to STEACS (25 (52,1%) vs 12 (26,1%), р=0,009). The same trend was observed when assessing the average number of stenoses and occlusions of the coronary arteries. PCI was performed in 43 (74,1%) of the deceased and 43 (93,5%) of the surviving STEACS patients with CS (p=0,009). The follow-up group had a higher rate of unsuccessful PCI (30,2%) vs 3 (7%), р=0,001) and performed later than 6 hours after the onset of an angina attack (28 (65,1%) vs 6 (14%), р=0,0001).Summary. Hospital mortality in patients with STEMI complicated by CS was associated with the presence left ventricular ejection fraction less than 40%, three-vessel coronary lesion and performing PCI later than 6 hours from the beginning of the pain attack.

scholarly journals Prediction of Left Main Coronary Artery Occlusion by ST Segment Elevation in Lead aVR Greater than that in Lead V1 in Acute Coronary Syndrome

2017 ◽  
Vol 9 (2) ◽  
pp. 77-82
Author(s):  
Abdul Azeez Ahemd ◽  
Mahboob Ali ◽  
Abdullah Al Shafi Majumder ◽  
M Atahar Ali ◽  
Md Shafiqur Rahman Patwary ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Left Ventricular ◽  
Left Main ◽  
Predictive Values ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Group I ◽  
St Segment ◽  
Lead Avr

Background: The electrocardiogram (ECG) predicting an acute obstruction of the LMCA, which requires immediate aggressive treatment, is very important for early diagnosis. We correlated ST segment elevation in lead aVR greater than that in lead V• with coronary angiographic diagnosis of LMCA occlusion in patients with acute coronary syndrome.Methods: Cross sectional analytical study was conducted in the Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh from August 2011 to July 2012. Total 90 patients were included purposively. Study population was divided into two groups. Group I- Patients with ST segment elevation in aVR greater than ST segment elevation in V• (n=45) and group II- Patients with ST segment elevation in aVR less than that in lead V• (n=45). In hospital outcomes were observed for cardiogenic shock, left ventricular failure, hypotension, arrhythmia and death.Results: Acute LVF was significantly (P<0.05) higher in group I but other complications were not significant (P>0.05) between two groups. LM involvement was significantly higher in group I (91.1% vs. 20.0%, p<0.05). ST segment elevation in aVR greater than ST segment elevation in V• (n=45) for prediction of LM significant disease has got a sensitivity of 82.0%, specificity 90.0%, accuracy 85.6%, positive and negative predictive values were 91.1% and 80.0% respectively.Conclusion: ST segment deviation in lead aVR greater than that in lead V1 is supposed to be a positive predictor of left main coronary artery obstruction with highly sensitivity and accuracy. Precordial leads V1 and V6 can also predict the critical LMCA obstruction in patients with acute coronary syndrome.Cardiovasc. j. 2017; 9(2): 77-82

First-degree atrioventricular block in acute anterior myocardial infarction

2020 ◽  
pp. 021849232097148
Author(s):  
Arvin Zabeh ◽  
Masoumeh Jahanafrouz ◽  
Babak Kazemi ◽  
Leili Pourafkari ◽  
Ghiti Davarmoin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Atrioventricular Block ◽  
Left Ventricular ◽  
Hospital Death ◽  
Anterior Myocardial Infarction ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Pr Interval

Background There is paucity of data regarding the prognostic implications of first-degree atrioventricular block in patients with acute anterior myocardial infarction as a distinct group. The aim of this study was to elucidate the association of prolonged PR interval with hospital clinical outcomes in patients with treated with thrombolysis. Methods Three hundred consecutive patients with a first acute anterior ST-segment elevation myocardial infarction undergoing thrombolysis between October 2017 and March 2018, were retrospectively enrolled in this study. They were divided into two groups based on PR interval on admission: PR interval ≤200 ms, and PR interval > 200 ms. Hospital mortality and complications were compared between the 2 groups. Results Of the 300 patients, 26 (8.66%) had first-degree atrioventricular block on initial presentation. Overall, hospital death occurred in 20 (6.66%) patients. Patients with PR interval > 200 ms had a higher hospital mortality rate (26.9%) than those without (4.7%, p < 0.001). In multivariate Cox regression analysis, only left ventricular systolic function and PR interval were independent predictors of hospital mortality (odds ratio = 1.031; 95% confidence interval: 1.008–1.056, p = 0.009 for PR interval). Conclusion In patients with a first acute anterior ST-segment elevation myocardial infarction treated with thrombolysis, first-degree atrioventricular block was associated with increased hospital mortality and a worse prognosis.

scholarly journals Cardiac rupture – the most serious complication of Takotsubo syndrome

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Zalewska-Adamiec ◽  
H Bachorzewska-Gajewska ◽  
S Dobrzycki
Keyword(s):  
Female Gender ◽  
Left Ventricular ◽  
Cardiac Rupture ◽  
Control Group ◽  
Mechanical Complication ◽  
Takotsubo Syndrome ◽  
St Segment Elevation ◽  
Glucose Levels ◽  
Risk Of Death ◽  
St Segment

Abstract Background The most serious complication of the acute Takotsubo phase is a myocardial perforation, which is rare, but it usually results in the death of the patient. Methods In the years 2008–2020, 265 patients were added to the Podlasie Takotsubo Registry. Cardiac rupture was observed in five patients (1.89%), referred to as the Takotsubo syndrome with complications of cardiac rupture (TS+CR) group. The control group consisted of 50 consecutive patients with uncomplicated TS. The diagnosis of TS was based on the Mayo Clinic Criteria. Results Cardiac rupture was observed in women with TS aged 74–88 years. Patients with TS and CR were older (82.20 vs. 64.84; p=0.011), than the control group, and had higher troponin, creatine kinase, aspartate aminotransferase, and blood glucose levels (168.40 vs. 120.67; p=0.010). The TS+CR group demonstrated a higher heart rate (95.75 vs. 68.38; p&lt;0.0001) and the Global Registry of Acute Coronary Events (GRACE) scores (186.20 vs. 121.24; p&lt;0.0001) than the control group. In patients with CR, ST segment elevation was recorded significantly more often in the III, V4, V5 and V6 leads. Left ventricular free wall rupture was noted in four patients, and in one case, rupture of the ventricular septum. In a multivariate logistic regression, the factors that increase the risk of CR in TS were high GRACE scores, and the presence of ST segment elevation in lead III. Conclusions Cardiac rupture in TS is rare but is the most severe mechanical complication and is associated with a very high risk of death. The main risk factors for left ventricular perforation are female gender, older age, a higher concentration of cardiac enzymes, higher GRACE scores, and ST elevations shown using electrocardiogram (ECG). FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Association between Natriuretic Peptides and Mortality among Patients Admitted with Myocardial Infarction: A Report from the ACTION Registry®–GWTG™

2013 ◽  
Vol 59 (8) ◽  
pp. 1205-1214 ◽  
Author(s):  
Benjamin M Scirica ◽  
Mitul B Kadakia ◽  
James A de Lemos ◽  
Matthew T Roe ◽  
David A Morrow ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Hospital Mortality ◽  
Natriuretic Peptides ◽  
Left Ventricular ◽  
Blood Concentrations ◽  
Clinical Model ◽  
St Segment Elevation ◽  
C Statistic ◽  
St Segment

BACKGROUND Patients with increased blood concentrations of natriuretic peptides (NPs) have poor cardiovascular outcomes after myocardial infarction (MI). The objectives of this analysis were to evaluate the utilization and the prognostic value of NP in a large, real-world MI cohort. METHODS Data from 41 683 patients with non–ST-segment elevation MI (NSTEMI) and 27 860 patients with ST-segment elevation MI (STEMI) at 309 US hospitals were collected as part of the ACTION Registry®–GWTG™ (Acute Coronary Treatment and Intervention Outcomes Network Registry–Get with the Guidelines) (AR-G) between July 2008 and September 2009. RESULTS B-type natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP) was measured in 19 528 (47%) of NSTEMI and 9220 (33%) of STEMI patients. Patients in whom NPs were measured were older and had more comorbidities, including prior heart failure or MI. There was a stepwise increase in the risk of in-hospital mortality with increasing BNP quartiles for both NSTEMI (1.3% vs 3.2% vs 5.8% vs 11.1%) and STEMI (1.9% vs 3.9% vs 8.2% vs 17.9%). The addition of BNP to the AR-G clinical model improved the C statistic from 0.796 to 0.807 (P &lt; 0.001) for NSTEMI and from 0.848 to 0.855 (P = 0.003) for STEMI. The relationship between NPs and mortality was similar in patients without a history of heart failure or cardiogenic shock on presentation and in patients with preserved left ventricular function. CONCLUSIONS NPs are measured in almost 50% of patients in the US admitted with MI and appear to be used in patients with more comorbidities. Higher NP concentrations were strongly and independently associated with in-hospital mortality in the almost 30 000 patients in whom NPs were assessed, including patients without heart failure.

Intraventricular conduction defects in patients with st-segment elevation myocardial infarction – the paradox of right bundle branch block

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Fernandes ◽  
F Montenegro ◽  
M Cabral ◽  
R Carvalho ◽  
L Santos ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Right Bundle Branch Block ◽  
Independent Predictor ◽  
Left Ventricular Ejection ◽  
Bundle Branch Block ◽  
Hospital Outcomes ◽  
St Segment Elevation ◽  
Intraventricular Conduction ◽  
St Segment ◽  
Worse Prognosis

Abstract   Intraventricular conduction defects (IVCD) in patients with acute myocardial infarct (AMI) are predictors of a worse prognosis. When acquired they can be the result of an extensive myocardial damage. Purpose To assess the impact of IVCD, regardless of being previously known or presumed new, on in-hospital outcomes of patients with AMI with ST segment elevation (STEMI) or undetermined location. Methods From a series of patients included in the National Registry of Acute Coronary Syndrome between 10/1/2010 and 9/1/2019, were selected patients with STEMI or undetermined AMI, undergoing coronary angiography. Results 7805 patients were included: 461 (5.9%) presenting left bundle branch block (LBBB), 374 (4.8%) with right bundle branch block (RBBB) and 6970 (89.3%) with no IVCD. Clinical characteristics as well as in-hospital outcomes are described in the table 1. An unexpected worse prognosis in patients with RBBB has motivated a multivariate analysis. RBBB remained an independent predictor of in-hospital mortality (OR 1.91, 95% CI 1.04–3.50, p=0.038), along with female gender (OR 1.73, 95% CI 1.11–2.68, p=0.015), Killip Class&gt;1 (OR 2.26, 95% CI 1.45–3.53, p&lt;0.001), left ventricular ejection fraction &lt;50% (OR 3.93, 95% CI 2.19–7.05, p&lt;0.001) and left anterior descending artery as the culprit lesion (OR 1.85, 95% CI 1.16–2.91, p=0.009). Conclusion In spite of an apparent better clinical profile, in the current large series of unselected STEMI patients, the presence of RBBB is associated with the worst in-hospital outcome. RBBB doubles the risk of death, being an independent predictor of in-hospital mortality. Funding Acknowledgement Type of funding source: None

scholarly journals Analysis of risk factors for different subtypes of acute coronary syndrome

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110083
Author(s):  
Lei Zhang ◽  
Juledezi Hailati ◽  
Xiaoyun Ma ◽  
Jiangping Liu ◽  
Zhiqiang Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Brain Natriuretic Peptide ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Amino Terminal ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Aims To investigate the different risk factors among different subtypes of patients with acute coronary syndrome (ACS). Methods A total of 296 patients who had ACS were retrospectively enrolled. Blood and echocardiographic indices were assessed within 24 hours after admission. Differences in risk factors and Gensini scores of coronary lesions among three groups were analyzed. Results Univariate analysis of risk factors for ACS subtypes showed that age, and levels of fasting plasma glucose, amino-terminal pro-brain natriuretic peptide, and creatine kinase isoenzyme were significantly higher in patients with non-ST-segment elevation myocardial infarction (NSTEMI) than in those with unstable angina pectoris (UAP). Logistic multivariate regression analysis showed that amino-terminal pro-brain natriuretic peptide and the left ventricular ejection fraction (LVEF) were related to ACS subtypes. The left ventricular end-diastolic diameter was an independent risk factor for UAP and ST-segment elevation myocardial infarction (STEMI) subtypes. The severity of coronary stenosis was significantly higher in NSTEMI and STEMI than in UAP. Gensini scores in the STEMI group were positively correlated with D-dimer levels (r = 0.429) and negatively correlated with the LVEF (r = −0.602). Conclusion Different subtypes of ACS have different risk factors. Our findings may have important guiding significance for ACS subtype risk assessment and clinical treatment.

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