scholarly journals Management and Outcomes of ST-segment Elevation Myocardial Infarction During Coronavirus 2019 Pandemic in a Center with 24/7 Primary Angioplasty Capability: Should We Change Our Practice During Outbreak?

2020 ◽  
Author(s):  
Mojtaba Salarifar ◽  
Mojgan Ghavami ◽  
Hamidreza Poorhosseini ◽  
Farzad Masoudkabir ◽  
Yaser Jenab ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Tissue ◽  
Tissue Injury ◽  
Coronary Intervention ◽  
Primary Angioplasty ◽  
Ct Imaging ◽  
Cardiac Events ◽  
Mortality And Morbidity ◽  
St Segment Elevation ◽  
The Difference

AbstractBackgroundST-Elevation Myocardial Infarction (STEMI) is associated with high mortality and morbidity. In order to minimize cardiac tissue injury, primary per-cutaneous coronary intervention (PPCI) as treatment of choice should be performed as soon as possible. Coronavirus Disease 2019 (COVID-19) as an ongoing major global concern affects the other parts of health care system. Applying preventive strategies during this outbreak is necessary. However, critical times in STEMI management and outcomes may be influenced by infection control protocols implementation. The aim of this study is to investigate the differences in time intervals related to STEMI care and 15-day major adverse cardiac events (MACE) during this outbreak compared with the same period in last year and to determine whether the STEMI protocol should be changed to thrombolytic therapy during COVID-19 outbreak or not.MethodsThe patients with STEMI who underwent PPCI in Tehran Heart Center were included. Chest Computed tomography (CT) imaging and real time Reverse Transcription Polymerase Chain Reaction (rRT-PCR) were only performed for COVID-19 suspected patients. Seventy-seven patients from 29th February to 29th March 2020 were compared with 62 patients from 1st to 30th March 2019.ResultsCOVID-19 infection was confirmed by rRT-PCR in 5 cases. CT imaging in 4 out of 5 patients was in favor of COVID-19. The median of door-to-device time was reduced 13 minutes during this outbreak (p: 0.007). In-hospital mortality before and during outbreak was 3.22% and 5.19%, respectively (p: 0.57). Confirmed infection with COVID-19 was only reported in one of expired cases. The difference in 15-day MACE between two time periods was not statistically significant.Discussion/ConclusionGiven that 15-day outcome in acute STEMI patients is not affected by COVID-19 outbreak, we did not find it reasonable to change our protocol. However, further studies are needed to determine a standard protocol for emergency management.

Prognostic impact of SYNTAX II score in patients with cardiogenic shock complicating ST-elevation myocardial infarction: analysis of an 10-year all-comers registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Juskova ◽  
P Tasende Rey ◽  
B Cid Alvarez ◽  
B Alvarez Alvarez ◽  
J.M Garcia Acuna ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Independent Predictor ◽  
Coronary Intervention ◽  
Prognostic Impact ◽  
Cardiac Events ◽  
Prognostic Information ◽  
St Segment Elevation ◽  
All Cause Mortality

Abstract Background The SYNTAX II score (SS-II) can predict 4-year outcomes in patients with complex coronary artery disease and ST-segment elevation myocardial infarction (STEMI). Nonetheless, the prognostic value of SS-II for a cardiogenic shock (CS) in the setting of STEMI has not been assessed. Purpose This study aimed to investigate the predictive impact of SS-II in patients with CS complicating STEMI undergoing primary percutaneous coronary intervention, and whether SS-II adds prognostic information to predict major adverse cardiac events (MACE) and all-cause death in this population. Methods This prospective cohort study included 1965 consecutive patients with STEMI who underwent primary-PCI between January 2008 and December 2017. The cohort of patients with CS (n=153) was identified and divided into three groups based on SS-II tertiles [SS-II low tertile <38 (n=51), ≥38 SS-II intermediate tertile <47 (n=51), and SS-II high tertile ≥48 (n=51)]. Results Amongst the cohort of patients with CS mean age was 68.4±14.0 years, 69.2% were male and 51.6% presented with anterior STEMI (mean SSII was 45.1±14). In-hospital mortality was significantly higher in the high SS-II tertile (85.7% vs. 38.9% vs 24.4%, p≤0.001) compared with SS-II intermediate and low tertiles. During follow-up (median 2.5 years), SS-II was positively correlated with MACE (89.3% (high SS-II) vs. 52.8% (int SS-II) vs. 42.2% (low SS-II), p≤0.001), and with all-cause mortality (89.3% vs 44.4% vs 26.7%, p≤0.001). The SS-II was also an independent predictor of MACE (HR=1.042, 95% CI: 1.020–1.063, p=0.000) and all-cause mortality during follow-up (HR=1.056, 95% CI: 1.033–1.079, p=0.000) Conclusion In a real-world cohort of patients with STEMI related CS, the SS-II added important prognostic information, being an independent predictor of MACE and all-cause mortality during follow-up. Image 1 Funding Acknowledgement Type of funding source: None

scholarly journals Eosinophil percentage as a new prognostic marker in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

2020 ◽  
Vol 11 (3) ◽  
pp. 146-153
Author(s):  
Ahmet Güner ◽  
Regayİp Zehİr ◽  
Macİt KalçIk ◽  
Abdulkadİr Uslu ◽  
Altuğ Ösken ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Intervention ◽  
Inhospital Mortality ◽  
Cardiac Events ◽  
St Segment Elevation ◽  
Target Vessel Revascularization ◽  
Segment Elevation Myocardial Infarction ◽  
Group 4 ◽  
St Segment ◽  
Adverse Cardiac Events

Background In addition to proinflammatory properties, eosinophils can stimulate platelet activation and enhance prothrombotic pathways. In this study, we aimed to investigate the association between the eosinophil percentage (EOS%) and major adverse cardiac events (MACE) in patients with ST-segment elevation myocardial infarction (STEMI). Methods This study enrolled a total of 1,909 patients who were diagnosed with STEMI. Ventricular arrhythmia, reinfarction, the need for cardiopulmonary resuscitation, target vessel revascularization, congestive heart failure, and cardiovascular mortality during index hospitalization were defined as MACE. Results Three hundred and eighty patients (19.7%) reached the combined endpoint with MACE. The rates of inhospital mortality and MACE were significantly higher in low EOS% group as compared to high EOS% group (4% vs. 1.1%, p < 0.01 and 32.8% vs. 11.3%, p < 0.01, respectively). On multivariate logistic regression analyses, EOS% (OR = 0.44, p < 0.01) was found to be one of the independent predictors of MACE. The EOS% lower than 0.60 on admission predicted inhospital MACE with a sensitivity of 68% and a specificity of 72% (AUC: 0.684, p < 0.01). Conclusions Low EOS% on admission may be associated with high inhospital MACE in STEMI patients. EOS% may be used as a novel biomarker for risk stratification of these patients.

Early Treatment of ST-segment-elevation Myocardial Infarction Incorporating Results of the FINESSE Trial

2009 ◽  
Vol 5 (1) ◽  
pp. 85 ◽  
Author(s):  
Luc Janssens ◽  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Trials ◽  
Clinical Benefit ◽  
Bleeding Risk ◽  
Risk Groups ◽  
Coronary Intervention ◽  
Primary Angioplasty ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

A significant mortality reduction has been observed in the last few decades in the treatment of ST-segment-elevation myocardial infarction (STEMI), mainly due to pharmacological and/or mechanical reperfusion therapies. Primary angioplasty has provided further survival benefits compared with thrombolysis. Treatment delays are still common for patients with STEMI who are referred for primary percutaneous coronary intervention (PCI), and have led to clinical trials evaluating the possible clinical benefit of ‘facilitated’ PCI. Clinical trials – principally Facilitated Intervention with Enhanced Reperfusion Speed to Stop Events (FINESSE) – were not able to demonstrate a net clinical benefit of pre-PCI pharmacological reperfusion with thrombolytics, glycoprotein IIb/IIIa inhibitors or a combination of both therapies. At the same time, the data suggest further study may be needed in certain high-risk groups to address the need to find therapies that improve reperfusion without greatly increasing bleeding risk.

scholarly journals Acute Serious Thrombocytopenia Associated with Intracoronary Tirofiban Use for Primary Angioplasty

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Mustafa Yurtdaş ◽  
Yalin Tolga Yaylali ◽  
Nesim Aladağ ◽  
Mahmut Özdemir ◽  
Memiş Hilmi Atay
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Primary Angioplasty ◽  
Successful Management ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary

Tirofiban, a specific glycoprotein IIb/IIIa inhibitor, may cause extensive thrombocytopenia with an incidence of 0.2% to 0.5%. We report the case of a 50-year-old man who developed thrombocytopenia after tirofiban use (both intracoronary and peripheral) over hours and the successful management of this complication after primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction.

scholarly journals PACAP-38 in Acute ST-Segment Elevation Myocardial Infarction in Humans and Pigs: A Translational Study

2021 ◽  
Vol 22 (6) ◽  
pp. 2883
Author(s):  
Dora Szabo ◽  
Zsolt Sarszegi ◽  
Beata Polgar ◽  
Eva Saghy ◽  
Adam Nemeth ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Tissue ◽  
Coronary Intervention ◽  
Significant Negative Correlation ◽  
St Segment Elevation ◽  
Translational Study ◽  
Segment Elevation Myocardial Infarction ◽  
Ischemic Region ◽  
St Segment ◽  
Potential Biomarker

Acute myocardial infarction (MI) is one of the most common causes of death worldwide. Pituitary adenylate cyclase activating polypeptide (PACAP) is a cardioprotective neuropeptide expressing its receptors in the cardiovascular system. The aim of our study was to examine tissue PACAP-38 in a translational porcine MI model and plasma PACAP-38 levels in patients with ST-segment elevation myocardial infarction (STEMI). Significantly lower PACAP-38 levels were detected in the non-ischemic region of the left ventricle (LV) in MI heart compared to the ischemic region of MI-LV and also to the Sham-operated LV in porcine MI model. In STEMI patients, plasma PACAP-38 level was significantly higher before percutaneous coronary intervention (PCI) compared to controls, and decreased after PCI. Significant negative correlation was found between plasma PACAP-38 and troponin levels. Furthermore, a significant effect was revealed between plasma PACAP-38, hypertension and HbA1c levels. This was the first study showing significant changes in cardiac tissue PACAP levels in a porcine MI model and plasma PACAP levels in STEMI patients. These results suggest that PACAP, due to its cardioprotective effects, may play a regulatory role in MI and could be a potential biomarker or drug target in MI.

scholarly journals Acute coronary syndrome in the young Nepalese population with their angiographic characteristics

2017 ◽  
Vol 13 (2) ◽  
pp. 235-240
Author(s):  
Shankar Laudari ◽  
Sachin Dhungel ◽  
Laxman Dubey ◽  
Rajesh Panjiyar ◽  
Madhu Gupta ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Coronary Intervention ◽  
Systemic Hypertension ◽  
Coronary Risk Factors ◽  
Cardiac Events ◽  
Cross Sectional ◽  
St Segment Elevation ◽  
Coronary Syndrome

Background & Objectives: Acute coronary syndrome (ACS) is an emerging cardiac problem in the young population in Asia and Nepalese population is not an exception to this. Early ACS in young age imparts huge familial and social economic burden. Early identification and proper management strategy is still a challenging problem in developing countries like Nepal where there are limited coronary intervention centers. The study was conducted with objective to study the clinical spectrum, etiologies, coronary angiographic characteristics and their clinical outcomes.Materials & Methods:  This is a cross-sectional study carried out in a tertiary hospital in central Nepal. Forty patients with acute coronary syndrome with age less than 40 years were enrolled in the study.Results: Majority of the patients were males with male: female=1.8:1. Twenty six (65%) patients were having ST segment elevation myocardial infarction followed by non-ST elevation myocardial infarction in nine (22.50%) patients and unstable angina in five (12.50%). patients. The most common risk factors were smoking, systemic hypertension, diabetes mellitus and dyslipidemia. Majority were having single vessel disease. Twenty (50%) patients had undergone primary angioplasty followed by thrombolysis in seven patients and the rest were managed medically because of late presentation. In-hospital major adverse cardiac events and mortality were higher among STEMI than NSTEMI and unstable angina.Conclusion: Acute coronary syndrome in the young is increasing in the Nepalese population. This group of population should be well educated and made aware of the potential coronary risk factors and their modification. 

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