P3600High-sensitivity troponin I can predict reduced TIMI coronary grade flow in patients with suspected myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Schaefer ◽  
J T Neumann ◽  
N A Soerensen ◽  
A Gossling ◽  
F Ojeda ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Troponin I ◽  
Bypass Graft ◽  
Absolute Value ◽  
Timi Grade ◽  
Group 2 ◽  
Distinguished Group ◽  
Group 1

Abstract Background Serial measurements of high-sensitivity troponin (hs-Tn) is recommended for rule-out or rule-in of myocardial infarction (MI) in patients presenting with acute chest pain. Based on dynamic hs-Tn changes invasive angiography is recommended in order to identify a culprit lesion. However, the association of hs-Tn with the intracoronary flow is unknown. Purpose We aimed to evaluate the association of hs-TnI with intracoronary flow, measured by the TIMI Coronary Grade Flow in coronary angiography, and its association with outcome. Methods 1,940 consecutive patients presenting with suspected MI to the emergency department were included. Among those 543 patients underwent coronary angiography. Patients with prior coronary artery bypass graft surgery and patients with chronic total occlusion were excluded from further analysis, resulting in 420 available individuals. TIMI Coronary Grade Flow was scored in accordance with the definition of the TIMI study group. For further analysis two groups were distinguished. Group 1: Minimum TIMI Grade Flow <3 (no complete perfusion in at least one of the coronary arteries) and Group 2: Minimum TIMI Grade Flow = 3 (normal flow in all coronary arteries). Troponin I was measured using the ARCHITECT STAT high sensitive Troponin I immunoassay directly at admission, after 1 and 3 hours. Receiver Operating Characteristic (ROC) curves were used to investigate the association of hs-TnI with a reduced TIMI Grade Flow. Survival curves were produced for a combined endpoint of all-cause mortality, rehospitalisation, PCI and MI after 12 months. Results In patients with reduced TIMI Grade Flow the level of hs-TnI was significantly higher at admission (Group 2: 87.3 ng/l vs. Group 1: 15.0 ng/l, p<0.001), after 1 hour (298.3 ng/l vs 18.5 ng/l, p<0.001) and after 3 hours (1,071 ng/l vs. 27.7 ng/l, p<0.001). The prediction of reduced TIMI flow based on the absolute value of hs-TnI improved over time from admission (AUC 0.701, optimal cut off 34.8 ng/l, 95% CI (9.7, 74.6)), to 1 hour (AUC 0.759, optimal cut off 65.1 ng/l, 95% CI (25.1, 279.5)) and 3 hours (AUC 0.777, optimal cut off 90.7 ng/l, 95% CI (14.8, 200)). Using the hs-TnI delta to predict a reduced TIMI Grade Flow improved the accuracy only slightly with time from admission: hs-TnI 0/1h delta (AUC 0.758) vs. 0/3h delta (AUC 0.765). The survival curve for a combined endpoint after one year was significantly reduced in patients with reduced TIMI Grade Flow (Figure 1, p=0.012) Figure 1 Conclusion Absolute value and delta change of hs-TnI after 1 and 3 hours help to predict the presence of reduced TIMI Grade Flow in coronary arteries. Patients suffering from a lowered TIMI Grade Flow have higher event rates after 12-months.

scholarly journals The outcome of patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) and impaired kidney function: a 3-year observational study

2021 ◽  
Author(s):  
Malgorzata Zalewska-Adamiec ◽  
Jolanta Malyszko ◽  
Ewelina Grodzka ◽  
Lukasz Kuzma ◽  
Slawomir Dobrzycki ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Incidence Rate ◽  
Kidney Function ◽  
Coronary Arteries ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Risk Of Death ◽  
Group 2 ◽  
Group 1

Abstract Background Myocardial infarction with nonobstructive coronary arteries (MINOCA) constitutes about 10% of the cases of acute coronary syndromes (ACS). It is a working diagnosis and requires further diagnostics to determine the cause of ACS. Methods In this study, 178 patients were initially diagnosed with MINOCA over a period of 3 years at the Department of Invasive Cardiology of the University Clinical Hospital in Białystok. The value of estimated glomerular filtration rate (eGFR) was calculated for all patients. The patients were divided into 2 groups depending on the value of eGFR: group 1—53 patients with impaired kidney function (eGFR < 60 mL/min/1.73 m2; 29.8%) and group 2—125 patients with normal kidney function (eGFR ≥ 60 mL/min/1.73 m2; 70.2%). Results In group 1, the mean age of patients was significantly higher than that of group 2 patients (77.40 vs 59.27; p < 0.0001). Group had more women than group 2 (73.58% vs 49.60%; p = 0.003). Group 1 patients had higher incidence rate of arterial hypertension (92.45% vs 60.80%; p < 0.0001) and diabetes (32.08% vs 9.60%; p = 0.0002) and smoked cigarettes (22.64% vs 40.80%; p = 0.020). Group 1 patients had higher incidence rate of pulmonary edema, cardiogenic shock, sudden cardiac arrest (13.21% vs 4.00%; p = 0.025), and pneumonia (22.64% vs 6.40%; p = 0.001). After the 37-month observation, the mortality rate of the patients with MINOCA was 16.85%. Among group two patients, more of them became deceased during hospitalization (7.55% vs 0.80%; p = 0.012), followed by after 1 year (26.42% vs 7.20%; p = 0.0004) and after 3 years (33.96% vs 9.6%; p < 0.0001). Multivariate analysis revealed that the factors increasing the risk of death in MINOCA are as follows: older age, low eGFR, higher creatinine concentration, low left ventricular ejection fraction, and ST elevation in ECG. Conclusion Impaired kidney function is diagnosed in every third patient with MINOCA. Early and late prognosis of patents with MINOCA and renal dysfunction is poor, and their 3-year mortality is comparable to patients with myocardial infarction with significant stenosis of the coronary arteries and impaired kidney function.

Abstract 901: Impact of Microvascular Dysfunction on Long-Term Cardiovascular Events after Primary Coronary Intervention for Acute Myocardial Infarction in Patients Achieving TIMI Grade 3 Reperfusion

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Koichi Tamita ◽  
Atsushi Yamamuro ◽  
Syuichiro Kaji ◽  
Minako Katayama ◽  
Tomoko Tani ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Microvascular Dysfunction ◽  
Coronary Intervention ◽  
Cardiovascular Outcomes ◽  
Timi Grade ◽  
Group 2 ◽  
Grade 3 ◽  
Group 1

It has been reported that even if TIMI 3 flow is achieved in epicardial coronary arteries after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI), microvascular dysfunction results in insufficient reperfusion. Recent studies have shown that microvascular injury can be assessed from coronary flow velocity (CFV) pattern. The aim of this prospective study was to examine whether the CFV pattern predicts the long-term cardiovascular outcomes in AMI patients who achieved TIMI grade 3 reperfusion. The study population consisted of 161 consecutive patients with a first anterior AMI successfully treated with primary PCI (≤50% residual stenosis with TIMI grade 3). We examined the CFV pattern immediately after PCI using a Doppler guidewire. We defined microvascular dysfunction as a diastolic deceleration time ≤600 ms and the presence of systolic flow reversal. Patients were divided into two groups: those without microvascular dysfunction (n=126; group 1) and those with micriovascular dysfunction (n=35; group 2). We evaluated the association between the microvascular dysfunction and the long-term major adverse cardiovascular event (MACE) rates. The Kaplan-Meier survival curves showed that group 2 was poorer than group 1 in prognosis (p=0.0014). Risk-adjusted data by multivariate analysis showed that the microvascular dysfunction was the strongest predictor for long-term MACE (hazard ratio: 3.37; 95% CI, 1.59–7.15; p=0.0015). The CFV pattern immediately after PCI is an accurate predictor of the long-term cardiovascular outcomes in patients with AMI who achieved TIMI grade 3 reperfusion.

scholarly journals Does High Thoracic Epidural Analgesia with Levobupivacaine Preserve Myocardium? A Prospective Randomized Study

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Serife Gokbulut Bektas ◽  
Sema Turan ◽  
Umit Karadeniz ◽  
Burcin Ozturk ◽  
Soner Yavas ◽  
...  
Keyword(s):  
Troponin I ◽  
Randomized Study ◽  
Bypass Graft ◽  
Coronary Bypass ◽  
Thoracic Epidural ◽  
Haemodynamic Parameters ◽  
Total Antioxidant ◽  
Group 2 ◽  
High Thoracic Epidural ◽  
Group 1

Background. Our study aimed to compare HTEA and intravenous patient-controlled analgesia (PCA) in patients undergoing coronary bypass graft surgery (CABG), based on haemodynamic parameters and myocardial functions.Materials and Methods. The study included 34 patients that were scheduled for elective CABG, who were randomly divided into 2 groups. Anesthesia was induced and maintained with total intravenous anesthesia in both groups while intravenous PCA with morphine was administered in Group 1 and infusion of levobupivacaine was administered from the beginning of the anesthesia in Group 2 by thoracic epidural catheter. Blood samples were obtained presurgically, at 6 and 24 hours after surgery for troponin I, creatinine kinase-MB (CK-MB), total antioxidant capacity, and malondialdehyde. Postoperative pain was evaluated every 4 hours until 24 hours via VAS.Results. There were significant differences in troponin I or CK-MB values between the groups at postsurgery 6 h and 24 h. Heart rate and mean arterial pressure in Group 1 were significantly higher than in Group 2 at all measurements. Cardiac index in Group 2 was significantly higher than in Group 1 at all measurements.Conclusion. Patients that underwent CABG and received HTEA had better myocardial function and perioperative haemodynamic parameters than those who did not receive HTEA.

SOLELY INFARC-RELATED ARTERY VERSUS STAGED PERCUTANEOUS CORONARY INTERVENTION IN ST ELEVATION MYOCARDIAL INFARCTION PATIENTS WITH MULTIVESSEL CORONARY DISEASE

2014 ◽  
pp. 56-62
Author(s):  
Anh Tuan Ho ◽  
Van Dien Nguyen ◽  
Anh Tien Hoang
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Percutaneous Coronary ◽  
Infarct Related Artery ◽  
St Elevation ◽  
Group 2 ◽  
Group 1

Today, there are different interventional approaches for patients undergoing ST elevation myocardial infarction (STEMI) with multiple vessel diseases. Objectives: to compare the mid-term results of two strategies of myocardial revascularization used for the management of patients with STEMI with multiple vessel diseases. Material and methods: we analyzed retrogradely 64 profiles of patients diagnosed STEMI with multiple vessel diseases on coronary angiography and underwent angioplasty in Cardiovascular department from 5/2013 – 1/2014. The patients had been divided into 2 groups: group 1 (percutaneous coronary intervention (PCI) of the sole Infarct-related artery followed by medical therapy, n=33) and group 2 (staged PCI in STEMI patients with multiple vessel diseases, n=31). Results: group 2 had comparable combined end-points (death + Myocardial infarction + revascularization) rate but higher rate of detection of significantly stenosed non-culprit vessels than those of group 1. Conclusion: for the STEMI patients with multiple vessel diseases admitted to Hue University hospital, staged PCI was better than PCI of the sole infarct-related artery in term of omitting less patients who were appropriate for revascularization (these patients had no indication for coronary artery bypass graft). However, these two approaches had no statistical difference regarding to major adverse cardiac events. Key words: Acute myocardial infarction, Multivessel disease, Primary percutaneous coronary intervention

scholarly journals Typical ST-segment elevation myocardial infarction with normal coronary arteries: a case report

2019 ◽  
Vol 47 (11) ◽  
pp. 5903-5909
Author(s):  
Ying Rao ◽  
Yu Wang ◽  
Huang Sun ◽  
Wei Chen ◽  
Wenjuan Song ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Troponin I ◽  
Contrast Echocardiography ◽  
Coronary Spasm ◽  
Imaging Method ◽  
St Segment Elevation ◽  
Plaque Disruption ◽  
St Segment

Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a potentially multipathogenic syndrome that affects a subgroup of patients who present with acute myocardial infarction yet have no significant coronary artery disease on angiography. We herein describe a 71-year-old man with typical angina who showed inferior ST-segment elevation on electrocardiography and an increased troponin-I level. Emergency coronary angiography showed no angiographic stenosis. Cardiac magnetic resonance imaging (CMR) and myocardial contrast echocardiography (MCE) with two-dimensional speckle tracking imaging (2D-STI) were performed after coronary angiography. Good consistency was observed between the CMR findings and MCE with 2D-STI findings in identifying the potential causes of MINOCA. We explored an imaging method that is potentially more effective and accurate than CMR, namely MCE combined with 2D-STI, to identify myocardial abnormalities when angiography reveals no obstruction. This application of MCE with 2D-STI may optimize timely treatment. MINOCA has various causes, and the patient in this case was discharged with aspirin, verapamil, and atorvastatin on the presumption that the infarct had arisen from either plaque disruption or coronary spasm. In this study, we analyzed the etiology, clinical diagnosis, and treatment of MINOCA with reference to the relevant literature.

Quantification of Coronary Artery Stenosis with 16-Slice MSCT in Patients before CABG Surgery: Comparison to Standard Invasive Coronary Angiography

2005 ◽  
Vol 8 (1) ◽  
pp. 42 ◽  
Author(s):  
C. Probst ◽  
A. Kovacs ◽  
C. Schmitz ◽  
W. Schiller ◽  
H. Schild ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Artery Bypass ◽  
Invasive Coronary Angiography ◽  
Bypass Graft ◽  
Heart Association ◽  
Artery Stenosis ◽  
Vessel Disease ◽  
Selective Coronary Angiography

Objective: Invasive, selective coronary angiography is the gold standard for evaluation of coronary artery disease (CAD) and degree of stenosis. The purpose of this study was to compare 3-dimensional (3D) reconstructed 16-slice multislice computed tomographic (MSCT) angiography and selective coronary angiography in patients before elective coronary artery bypass graft (CABG) procedure. Methods: Sixteen-slice MSCT scans (Philips Mx8000 IDT) were performed in 50 patients (42 male/8 female; mean age, 64.44 8.66 years) scheduled for elective CABG procedure. Scans were retrospectively electrocardiogram-gated 3D reconstructed. The images of the coronary arteries were evaluated for stenosis by 2 independent radiologists. The results were compared with the coronary angiography findings using the American Heart Association segmental classification for coronary arteries. Results: Four patients (8%) were excluded for technical reasons. Thirty-eight patients (82.6%) had 3-vessel disease, 4 (8.7 %) had 2-vessel disease, and 4 (8.7%) had an isolated left anterior descending artery stenosis. In the proximal segments all stenoses >50% (56/56) were detected by MSCT; medial segment sensitivity was 97% (73/75), specificity 90.3%; distal segment sensitivity was 90.7% (59/65), specificity 77%. Conclusion: Accurate quantification of coronary stenosis greater than 50% in the proximal and medial segments is possible with high sensitivity and specificity using the new generation of 16-slice MSCTs. There is still a tendency to overestimate stenosis in the distal segments. MSCT seems to be an excellent diagnostic tool for screening patients with possible CAD.

scholarly journals Electroangiographic Correlation of Simultaneous ST-Segment Elevations of Anterior and Inferior Segment: Who Is the Culprit?

2021 ◽  
pp. 263246362110155
Author(s):  
Pankaj Jariwala ◽  
Shanehyder Zaidi ◽  
Kartik Jadhav
Keyword(s):  
Myocardial Infarction ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Index Case ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Inferior Segment ◽  
The Right ◽  
Proximal Occlusion

Simultaneous ST-segment elevation (SST-SE) in anterior and inferior leads in the setting of ST-segment elevation myocardial infarction is often confounding for a cardiologist and further more challenging is the angiographic localization of the culprit vessel. SST-SE can be fatal as it jeopardizes simultaneously a larger area of myocardium. This phenomenon could be due to “one lesion, one artery,” “two lesions, one artery,” “two lesions, two arteries,” or combinations in two different coronary arteries. We have discussed an index case where we encountered a phenomenon of SST-SE and coronary angiography demonstrated “two lesions, one artery” (proximal occlusion and distal critical diffuse stenoses of the wrap-around left anterior descending [LAD] artery) and “two lesions, two (different coronary) arteries” (previously mentioned stenoses of the LAD artery and critical stenosis of the posterolateral branch of the right coronary arteries). We have also described in brief the possible causes of this phenomena and their electroangiographic correlation of the culprit vessels.

scholarly journals Appropriate secondary prevention and clinical outcomes after acute myocardial infarction according to atherothrombotic risk stratification: The FAST-MI 2010 registry

2018 ◽  
Vol 26 (4) ◽  
pp. 411-419 ◽  
Author(s):  
Victoria Tea ◽  
Marc Bonaca ◽  
Chekrallah Chamandi ◽  
Marie-Christine Iliou ◽  
Thibaut Lhermusier ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
High Risk ◽  
Secondary Prevention ◽  
High Risk Patients ◽  
Risk Patients ◽  
St Elevation ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background Full secondary prevention medication regimen is often under-prescribed after acute myocardial infarction. Design The purpose of this study was to analyse the relationship between prescription of appropriate secondary prevention treatment at discharge and long-term clinical outcomes according to risk level defined by the Thrombolysis In Myocardial Infarction (TIMI) Risk Score for Secondary Prevention (TRS-2P) after acute myocardial infarction. Methods We used data from the 2010 French Registry of Acute ST-Elevation or non-ST-elevation Myocardial Infarction (FAST-MI) registry, including 4169 consecutive acute myocardial infarction patients admitted to cardiac intensive care units in France. Level of risk was stratified in three groups using the TRS-2P score: group 1 (low-risk; TRS-2P=0/1); group 2 (intermediate-risk; TRS-2P=2); and group 3 (high-risk; TRS-2P≥3). Appropriate secondary prevention treatment was defined according to the latest guidelines (dual antiplatelet therapy and moderate/high dose statins for all; new-P2Y12 inhibitors, angiotensin-converting-enzyme inhibitor/angiotensin-receptor-blockers and beta-blockers as indicated). Results Prevalence of groups 1, 2 and 3 was 46%, 25% and 29% respectively. Appropriate secondary prevention treatment at discharge was used in 39.5%, 37% and 28% of each group, respectively. After multivariate adjustment, evidence-based treatments at discharge were associated with lower rates of major adverse cardiovascular events (death, re-myocardial infarction or stroke) at five years especially in high-risk patients: hazard ratio = 0.82 (95% confidence interval: 0.59–1.12, p = 0.21) in group 1, 0.74 (0.54–1.01; p = 0.06) in group 2, and 0.64 (0.52–0.79, p < 0.001) in group 3. Conclusions Use of appropriate secondary prevention treatment at discharge was inversely correlated with patient risk. The increased hazard related to lack of prescription of recommended medications was much larger in high-risk patients. Specific efforts should be directed at better prescription of recommended treatment, particularly in high-risk patients.

scholarly journals Surgical treatment of left ventricular wall rupture, regarded as a consequence of Takotsubo cardiomyopathy

2017 ◽  
Vol 5 ◽  
pp. 2050313X1668921 ◽  
Author(s):  
Taalaibek Kudaiberdiev ◽  
Irina Akhmedova ◽  
Gulzada Imanalieva ◽  
Ildar Abdildaev ◽  
Kilichbek Jooshev ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Angiography ◽  
Emotional Stress ◽  
Coronary Arteries ◽  
Takotsubo Cardiomyopathy ◽  
Laboratory Tests ◽  
Left Ventricular ◽  
Left Ventricular Aneurysm ◽  
Lv Function ◽  
Inferior Myocardial Infarction

Objective: We present the case of possible reverse type of TCM in a female patient presented with progressive left ventricular dysfunction and its rupture in pericardium. Methods: The detailed history, physical examination, laboratory tests, electrocardiography, serial echocardiography, coronary angiography with left ventriculography were performed to diagnose possible Takotsubo cardiomyopathy in 63-year old woman admitted to our center with complaints of dyspnea, lightheadedness, weakness and signs of hypotension and history of inferior myocardial infarction, acute left ventricular aneurysm, and effusive pericarditis and pleuritis, developed after emotional stress 5 months ago. Results: Clinical evaluation revealed unremarkable laboratory tests, normal troponin values, signs of old inferior myocardial infarction on electrocardiogram, and left ventricular (LV) dilatation and dysfunction, akinesia of LV infero-lateral wall with thinning and its rupture and blood shunting in pericardium. Her coronary angiography revealed normal coronary arteries. The diagnosis of pheochromocytoma was excluded. The patient underwent surgery under cardiopulmonary bypass with removal of LV pseudoaneurysm. The patient was discharged from hospital with improvement in NYHA class and LV function. Conclusion: Thus, in female postmenopausal patients presenting with acute myocardial infarction signs complicated by pericarditis, intact coronary arteries and LV dysfunction with emotional stress as triggering factor, reverse type of TCM should be considered and proper management applied to prevent development of life-threatening complications like LV rupture.

Growth differentiation factor 15 associations with clinical features of chronic heart failure with midrange ejection fraction and preserved ejection fraction depending on the history of myocardial infarction

Kardiologiia ◽  
2021 ◽  
Vol 61 (5) ◽  
pp. 59-64
Author(s):  
E. A. Kuzheleva ◽  
A. A. Garganeeva ◽  
V. A. Aleksandrenko ◽  
V. A. Fedyunina ◽  
O. N. Ogurkova
Keyword(s):  
Myocardial Infarction ◽  
Ejection Fraction ◽  
Stroke Volume ◽  
Inflammatory Marker ◽  
Left Ventricular Ejection ◽  
Growth Differentiation Factor 15 ◽  
Differentiation Factor ◽  
History Of ◽  
Group 2 ◽  
Group 1

Aim    To analyze associations between levels of the inflammatory marker, growth differentiation factor 15 (GDF-15), and echocardiographic indexes in CHF patients with mid-range and preserved left ventricular ejection fraction (LV EF) depending on the history of myocardial infarction (MI).Material and methods    This study included 34 CHF patients with preserved and mid-range LV EF after MI (group 1, n=19) and without a history of MI (group 2, n=15). Serum concentration of GDF-15 was measured with enzyme immunoassay (BioVendor, Czech Republic). Statistical analysis was performed with STATISTICA 10.0.Results    Patients of the study groups were age-matched [62 (58;67) and 64 (60;70) years, p=0.2] but differed in the gender; group 1 consisted of men only (100 %) whereas in group 2, the proportion of men was 53.3 % (p=0.001). Median concentration of GDF-15 was 2385 (2274; 2632.5) and 1997 (1534;2691) pg/ml in groups 1 and 2, respectively (p=0.09). Patients without MI showed a moderate negative correlation between LV EF and GDF-15 concentration (r= – 0.51, p=0.050) and a pronounced correlation between GDF-15 and LV stroke volume (r= –0.722, p=0.002). For patients after MI, a correlation between the level of GDF-15 and the degree of systolic dysfunction was not found (р>0.05).Conclusion    Blood concentration of the inflammatory marker, GDF-15, correlates with LV EF and stroke volume in CHF patients with preserved or mid-range LV EF and without a history of MI while no such correlations were observed for patients with a history of MI. 

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