scholarly journals 551 Killip class predictors and prognostic role in acute myocardial infarction

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Sara Amicone ◽  
Angelo Sansonetti ◽  
Matteo Armillotta ◽  
Francesco Angeli ◽  
Andrea Stefanizzi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Cardiac Troponin ◽  
Odds Ratio ◽  
Left Ventricle Ejection Fraction ◽  
Older Age ◽  
Killip Class ◽  
St Elevation ◽  
Time Of Presentation

Abstract Aims Killip classification is a simple and fast clinical tool for risk stratification in patients with acute coronary syndrome (ACS). However, predictors of high Killip class at admission and its prognostic impact in the clinical contest of myocardial infarction with nonobstructive coronary artery (MINOCA) are still poorly known. To identify the clinical predictors of high Killip class and its potential prognostic role on in-hospital and follow-up outcomes in patients with MINOCA compared to patients with myocardial infarction with obstructive coronary artery (MIOCA). Methods and results We included all consecutive patients with myocardial infarction (MI) undergoing coronary angiogram between 2016 and 2019 at our hospital. According to 2016 ESC Position Paper criteria, we considered as MINOCA all patients with acute MI and with the angiographic conventional cut-off of < 50% coronary stenosis without clinically apparent alternative diagnosis (e.g. sepsis, stroke, pulmonary embolism, myocarditis, and Tako-tsubo). We analysed Killip class of MINOCA patients comparing with those of MIOCA (coronary stenosis ≥50%). Kaplan–Meier (KM) curves were developed for the comparison of overall-mortality among MINOCA with high Killip class (major than 1) compared to other. Multivariate logistic regression analysis was used to determine the predictors of high Killip class both in the MINOCA and MIOCA populations. Among 3165 MI, 260 patients fulfilled the 2016 ESC criteria for MINOCA. Overall, 62.3% were males and the mean age was 68.6 ± 13.2 years. The median follow-up time was 23.3 ± 14.5 months. Killip class >1 occurred in 24 patients in MINOCA group and 507 in MIOCA group (17.5% vs. 9.2%, P = 0.001). The KM survival distributions were significantly different across Killip class >1 (P < 0.001) in both populations with higher mortality in patients with higher Killip class. Finally, the multivariate logistic regression showed that the predictors of high Killip class at time of presentation in MIOCA population were older age [odds ratio: 1.04, 95% CI: (1.03–1.06), P < 0.001], diabetes [odd ratio 0.63, 95% CI (0.48–0.81), P < 0.001], ST elevation [odds ratio: 0.65, 95% CI (0.48–0.89), P = 0.008], left ventricle ejection fraction [odds ratio: 0.95, 95% CI (0.94–0.96), P < 0.001], and elevated cardiac troponin [odds ratio: 1.00, 95% CI (1.00–1.00), P = 0.01]. Older age [odds ratio: 1.08, 95% CI (1.03–1.14), P = 0.003], ST elevation [odd ratio 0.14, 95% CI (0.02–0.93), P = 0.042], and diabetes [odd ratio 3.60, 95% CI (1.08–1.96), P = 0.037] were predictors of high Killip class in MINOCA, however left ventricle ejection fraction (P = 0.3) and elevated cardiac troponin (P = 0.6) did not predict the high Killip class in MINOCA patients. Conclusions Our data suggest that Killip classification performed at the time of admission is a useful clinical marker of a high risk of early and late adverse cardiovascular events even in patients with MINOCA. The predictors of the high Killip class at time of presentation in MIOCA were older age, diabetes, ST elevation, left ventricle ejection fraction, and elevated cardiac troponin. Older age, ST elevation, and diabetes were predictors of high Killip class even in MINOCA, however left ventricle ejection fraction and elevated cardiac troponin did not predict the high Killip class in MINOCA patients. These results could reflect the different pathogenetic myocardial damage in MINOCA and MIOCA populations. Further studies are needed to evaluate these pathological mechanisms.

scholarly journals Shahid Gangalal National Heart Centre-ST-elevation Myocardial infarction Registry (SGNHC-STEMI-Registry), Nepal

2020 ◽  
Vol 17 (1) ◽  
pp. 7-16
Author(s):  
Chandra Mani Adhikari ◽  
Kiran Prasad Acharya ◽  
Reeju Manandhar ◽  
Kunjang Sherpa ◽  
Rikesh Tamrakar ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Reperfusion Therapy ◽  
St Elevation Myocardial Infarction ◽  
Inferior Wall ◽  
Cross Sectional ◽  
Killip Class ◽  
National Heart ◽  
St Elevation ◽  
Time Of Presentation

Background and Aims: Incidence of ST-elevation myocardial infarction (STEMI) is increasing in Nepal. We aim to describe the presentation, management, complications, and outcomes of patients admitted with a diagnosis of STEMI in Shahid Gangalal National Heart Centre (SGNHC), Nepal. Methods: Shahid Gangalal National Heart Centre-ST-elevation registry (SGNHC-STEMI) registry was a cross sectional, observational, registry. All the patients who were admitted with the diagnosis of STEMI from January 2018 to December 2018 were included. Results: In this registry, 1460 patients out of 1486 patients who attended emergency were included. The mean age of patients was 60.8±13.4 years (range: 20 years to 98 years) with 70.3% male patients. Most of the patients (83.2%) were referred from other hospitals and 16.8% of patients directly attended the SGNHC emergency. During the presentation, smoking (54%) was the most common risk factor, followed by hypertension (36.6%), diabetes mellitus (25.3%), and dyslipidemia (7.8%). After admission, new cases of dyslipidemia, HTN, Impaired Fasting Glucose (IFG), and Type 2 DM were diagnosed in 682 (51.3%), 182 (20.1%), 148 (10.3%) and 95 (8.9%) respectively. At the time of presentation, 73.3% were in Killip class I and 26.3% were above Killip class II with 5.1% in cardiogenic shock. Thirty-one percent of the cases received reperfusion therapy (Primary percutaneous intervention in 25.2% and fibrinolysis in 5.8%). Inferior wall MI was the most common type of STEMI. Among the patients who underwent invasive therapy, the multi-vessel disease was noted in 46.2% cases and left main coronary artery involvement in 0.7% cases. In-hospital mortality was 6.2% with cardiogenic shock being the most common cause. Aspirin (97.8%), clopidogrel (96.2%), statin (96.4%), ACEI/ARB (76.8%) and beta-blocker (76.8%) were prescribed during discharge. Conclusion: The SGNHC-STEMI registry provides valuable information on the overall aspect of STEMI in Nepal. In general, the SGNHC-STEMI registry findings are consistent with other international data.

scholarly journals Influence of tobacco smoking on clinical efficacy of a 1-year rehabilitation programme for myocardial infarction patients of economically active age

2018 ◽  
Vol 17 (4) ◽  
pp. 26-33 ◽  
Author(s):  
M. G. Bubnova ◽  
D. M. Aronov ◽  
N. K. Novikova
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Smoking Status ◽  
Life Quality ◽  
Exercise Duration ◽  
Left Ventricle Ejection Fraction ◽  
Moderate Intensity ◽  
Physical Work ◽  
Load Duration

Aim. Evaluation of the efficacy of 1-year exercise based program (EP) in coronary heart disease (CHD) patients of economically active age after acute myocardial infarction (MI), depending on smoking status.Material and methods. To the study, males included (n=338) after MI (not later than 3 weeks from the event). Four groups shaped by randomization: EP patients smokers (group 1, n=84), EP non-smokers (group 2, n=85); no EP smokers (group 3, n=85) and no EP non-smokers (group 4, n=84). All patients received standard medication treatment. The EP were added, of moderate intensity (50-60% from the load in exercise test) 3 times a week during 1 year.Results. After EP in smokers (n=41) and non-smokers (n=85) there was an increase of load duration by 30,3% (p<0,001) and by 28,4% (p<0,001), and its intensity by 31,2% (p<0,001) and 30,8% (p<0,001), with 3,8% (p<0,01) increase of economicity of physical work, but only in smokers. With no EP only in non-smokers there was slight increase of exercise duration by 10,1% (p<0,01) and its intensity by 11,1% (p<0,05), but milder, and in smokers, in contrary, the economicity parameter declined by 13,3% (p<0,05). This was linked with the heart size enlargement and the left ventricle ejection fraction increase in smokers and non-smokers; in the absence of EP there were no changes, just slight (by 1,9%) (p<0,05) increase of the left ventricle ejection fraction in non-smokers. Only at EP, with similar grade in smokers and non-smokers there was decrease of atherogenic lipids levels and high density cholesterol increase. In 1 year of EP, all cases of cardiovascular adverse events significantly decreased in smokers by 44,8% (р<0,05) and in nonsmokers by 50,9% (р<0,05).Conclusion. Long term (1 year) EP of moderate intensity, in both smokers and non-smokers MI patients lead to stable disease course, decrease the rate of cardiovascuar complications and improve patients life quality. However the “smoking factor” decreases rehabilitational potentional of patient and interferes with better results achievement in cardiorehabilitation.

scholarly journals Anterior wall myocardial infarction in a young man caused by spontaneous dissection and hematoma of coronary artery

2019 ◽  
Vol 11 (2) ◽  
pp. 125-127
Author(s):  
Tomasz Bochenek ◽  
Michał Lelek ◽  
Katarzyna Mizia-Stec
Keyword(s):  
Myocardial Infarction ◽  
Optical Coherence Tomography ◽  
Coronary Artery ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Anterior Wall ◽  
Left Ventricle Ejection Fraction ◽  
Good Position ◽  
Good Clinical Condition ◽  
Spontaneous Dissection

A 55-year-old man without any cardiac history has been admitted to Ist Department of Cardiology due to anterior wall infarction. In echocardiography (ECG), local anterior wall dysfunction has been observed, with good left ventricle ejection fraction. In angiography performed immediately after transfer to hospital, long lesion in left anterior descending coronary artery has been visualized with high angiographic suspicion of dissection and intramural coronary hematoma. Intravascular ultrasound (IVUS) has been performed and further confirmed the diagnosis of hematoma – LAD was stented using three coronary stents. IVUS has confirmed good position of stents. Integrillin has been used. Periprocedural time was uncomplicated. ECG showed resolution of myocardial infarction pattern and evolution of infarction has been observed. The patient was discharged home in good clinical condition. Coronary dissection and coronary hematoma are the potential cause of infarction and IVUS, despite optical coherence tomography being reference nowadays, is still a very valuable tool in diagnosis and treatment guiding in such cases.

scholarly journals Superiority of wall motion score index over left ventricle ejection fraction in predicting cardiovascular events after an acute myocardial infarction

2016 ◽  
Vol 8 (1) ◽  
pp. 78-85 ◽  
Author(s):  
Alfonso Jurado-Román ◽  
Pilar Agudo-Quílez ◽  
Belén Rubio-Alonso ◽  
Javier Molina ◽  
Belén Díaz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Wall Motion ◽  
Myocardial Damage ◽  
Composite Endpoint ◽  
Left Ventricle Ejection Fraction ◽  
Wall Motion Score Index ◽  
Score Index

Background: There are few data on the prognostic significance of the wall motion score index compared with left ventricle ejection fraction after an acute myocardial infarction. Our objective was to compare them after the hyperacute phase. Methods: Transthoracic echocardiograms were performed in 352 consecutive patients with myocardial infarction, after the first 48 hours of admission and before hospital discharge (median 56.3 hours (48.2–83.1)). We evaluated the ability of the wall motion score index and left ventricular ejection fraction to predict the combined endpoint (mortality and rehospitalization for heart failure) as a primary objective and the independent events of the combined endpoint as a secondary objective. Results: In 80.7% of patients, the wall motion score index was high despite having an ejection fraction >40%. No patient had an ejection fraction <55% with a normal index. After a follow-up of 30.5 months (24.2–49.5), both variables were predictors of the composite endpoint and all-cause mortality ( p<0.0001), although only the wall motion score index was a predictor of readmission for heart failure ( p=0.007). By multivariate analysis, a wall motion score index >1.8 proved to be the most powerful predictor of the composite endpoint (hazard ratio: 8.5; 95% confidence interval 3.7–18.8; p<0.0001). The superiority of the wall motion score index over ejection fraction was especially significant in patients with less myocardial damage (non-ST elevation myocardial infarction, or left ventricle ejection fraction >40%). Conclusions: Both variables provide important prognostic information after a myocardial infarction. Beyond the hyperacute phase, wall motion score index is a more powerful prognostic predictor, especially in subgroups with less myocardial damage.

P1762Prognostic significance of in-hospital incomplete and terminated revascularization in patients with acute myocardial infarction and without reduced left ventricle ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P Francuz ◽  
T Podolecki ◽  
M Mazurek ◽  
L Wloch ◽  
A Swiatkowski ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Cox Regression ◽  
Myocardial Revascularization ◽  
Left Ventricle Ejection Fraction ◽  
Risk Of Death ◽  
Group 2 ◽  
Group 1

Abstract Introduction In-hospital incomplete and terminated at discharge myocardial revascularization has significant impact on mortality after acute myocardial infarction (AMI), also in patients (pts) with reduced left ventricle ejection fraction (LVEF) ≤35%. However, subjects with LVEF >35%, who are not candidates for implantable cardioverter defibrillators, are still at risk. Authors hypothesized, that in those pts, the prognosis could be related to completeness of revascularization. Purpose To evaluate the risk of death and major adverse cardiovascular events (MACE) among pts with AMI and LVEF>35% in relation to myocardial revascularization status. Methods Single center prospective study encompassed 445-pts with AMI and LVEF>35%, who were treated with percutaneous coronary intervention and who survived in-hospital period. Study population was divided into two groups: group 1. – 73-pts with in-hospital incomplete and terminated revascularization at discharge; group 2. – 372-pts with complete or incomplete revascularization, in whom scheduled procedures were planned and performed (either percutaneous or surgical). The incidence of death and MACE was compared between groups during mean follow-up of 47.5 months after AMI. MACE was defined as a composite of death, recurrent AMI, non-scheduled revascularization, acute heart failure, stroke. Independent predictors for death were identified with multivariate Cox-regression models and expressed as hazard ratio (HR) with 95% confidence interval (CI). Results Patients in group 1. had higher mortality rate than in group 2. (26.4% vs. 9.1%; p<0.001) – figure 1. The difference in the incidence of MACE was higher in group 1. than in group 2. (59.7% vs. 28.2%; p<0.001). The analysis of particular MACE showed, that in group 1. the incidence of recurrent AMI, non-scheduled revascularization and stroke was higher than in group 2. (17.8% vs. 8.9%; p=0.022, and 33.3% vs. 16.1%; p=0.001, and 6.8% vs. 2.4%; p=0.048, respectively). Independent risk factors for death were: age ≥65 years (HR: 4.2; CI: 2.1–8.0) and incomplete and terminated myocardial revascularization at hospital discharge (HR: 2.5; CI: 1.4–4.4). Conclusions After invasive treatment of AMI, the prognosis in patients with LVEF>35% is related to revascularization status. In-hospital incomplete and terminated revascularization at discharge is an independent risk factor for death in this population.

scholarly journals Predictors of left ventricle ejection fraction and early in-hospital mortality in patients with ST-segment elevation myocardial infarction: Single-center data from a tertiary referral university hospital in Istanbul

2019 ◽  
Vol 7 ◽  
pp. 205031211987178
Author(s):  
Samim Emet ◽  
Ali Elitok ◽  
Ekrem Bilal Karaayvaz ◽  
Berat Engin ◽  
Erdem Cevik ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Hospital Mortality ◽  
Troponin T ◽  
Left Ventricle Ejection Fraction ◽  
Tertiary Referral ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Background: Little is known about the management and mortality rates of ST-segment elevation myocardial infarction patients in developing countries. In this study, to expose independent predictors of early (24 h) in-hospital mortality and ejection fraction, we report our experience with 362 ST-segment elevation myocardial infarction patients admitted to the Istanbul Medical Faculty, Istanbul University, a tertiary referral university hospital, and treated with primary percutaneous intervention. Methods: This is a retrospective study that enrolled all patients (362) admitted with ST-segment elevation myocardial infarction to Department of Cardiology, Istanbul Medical Faculty, Istanbul University, between January 2015 and December 2016. The clinical characteristics of patients were collected retrospectively from medical chart review. Collected data were analyzed using IBM SPSS Statistics (version 21). Results: In the forward stepwise logistic regression analysis, target vessel diameter ( p = 0.001), systolic blood pressure ( p < 0.001), and troponin T levels ( p = 0.007) were independent predictors for early in-hospital mortality, while target vessel diameter ( p = 0.03), troponin T level ( p < 0.001), heart rate ( p = 0.001), and chest pain ( p = 0.001) duration were the independent predictors for ejection fraction of 50% and above. Conclusion: Our study is one of the few studies to investigate the predictors of early in-hospital mortality among patients hospitalized with ST-segment elevation myocardial infarction in a tertiary referral university hospital in a developing country. The identified predictors for mortality (including left ventricle ejection fraction and troponin T levels), left ventricle ejection fraction (including troponin T level, chest pain duration), and heart rate are consistent with what has been described in large registries in the United States and Europe.

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