scholarly journals Value of ST‐segment change in lead aVR in diagnosing left main disease in Non‐ST‐elevation acute coronary syndrome—A meta‐analysis

2019 ◽  
Vol 24 (6) ◽  
Author(s):  
Gien‐Kuo Lee ◽  
Yen‐Ping Hsieh ◽  
Shang‐Wei Hsu ◽  
Shou‐Jen Lan ◽  
Kshitij Soni
Keyword(s):  
Acute Coronary Syndrome ◽  
Meta Analysis ◽  
Left Main ◽  
Left Main Disease ◽  
Coronary Syndrome ◽  
St Segment ◽  
Lead Avr ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome

scholarly journals Significance of ST Segment Elevation in Lead aVR in Patients with Non-ST Elevation Acute Coronary Syndrome

2019 ◽  
Vol 14 (2) ◽  
pp. 71-76
Author(s):  
Pritam Kumar Gachchhadar ◽  
Manzoor Mahmood ◽  
Dipal Krishna Adhikary ◽  
MSI Tipu Chowdhury ◽  
Md Ashraf Uddin Sultan ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Area Under The Curve ◽  
Left Main ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Triple Vessel Disease ◽  
St Segment ◽  
Lead Avr ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome

Background: As acute occlusion of the left main (LM) artery causes life-threatening hemodynamic deterioration and malignant arrhythmias, resulting in an adverse outcome, a rapid diagnosis and subsequent urgent revascularization with percutaneous coronary intervention (PCI) or coronary bypass surgery is very important in this subset of patients. The 12-lead electrocardiogram (ECG) is a crucial tool in the diagnosis and risk stratification of acute coronary syndrome (ACS). Unlike other 11 leads, lead aVR has been long neglected until recent years. Objective: To determine the accuracy of 12-lead electrocardiography in predicting left main and/or triplevessel disease in patients with non-ST elevation acute coronary syndrome (NSTE- ACS). Methodology: This cross sectional observational study carried out among patients presenting with non-ST elevation acute coronary syndrome at Cardiac Emergency Department or CCU of BSMMU. This study was conducted from May 2017 to April 2018. A total of 36 patients meeting the eligibility criteria were consecutively included. Data collection was carried out by using a questionnaire. Informed written consent was obtained from the hospital authority. Analysis of data was finally done with Statistical Package for Social Science program 17 version of computer on the basis of different variables. Result: As ST-segment elevation in lead aVR is a continuous variable, a suitable cut-off for ST- elevation in lead aVR was found out for diagnosing LM and/or triple vessel disease (TVD) using ROC curve. The cut-off value was 0.75 mm which gave us an optimum sensitivity of 88.5% and a specificity of 80% with an area under the curve being 0.892(95% CI = 0.785-1.000), p < 0.001. The area under the curve demonstrated that 89.2% of the LM and/or TVD were correctly diagnosed with ST elevation e” 0.75 mm in lead aVR in patients with non-ST segment elevation acute coronary syndrome. The positive predictive value was commendably high (92%) and negative predictive value was no less (72.7%) with an overall diagnostic accuracy of 86%. Conclusion: From the findings of the study it can be concluded that ST- segment elevation e”0.75 mm in lead aVR in patients of non-ST segment elevation acute coronary syndrome had optimum sensitivity and specificity with an appreciably high overall diagnostic accuracy. The ST- segment elevation e”0.75 mm in lead aVR in patients with non-STE-ACS can differentiate LM and/or triple vessel disease with fair degree of accuracy. University Heart Journal Vol. 14, No. 2, Jul 2018; 71-76

scholarly journals Reappraisal of thienopyridine pretreatment in patients with non-ST elevation acute coronary syndrome: a systematic review and meta-analysis

BMJ ◽  
2014 ◽  
Vol 347 (aug06 2) ◽  
pp. g6269-g6269 ◽  
Author(s):  
A. Bellemain-Appaix ◽  
M. Kerneis ◽  
S. A. O'Connor ◽  
J. Silvain ◽  
M. Cucherat ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Coronary Syndrome ◽  
Meta Analysis ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome

Meta‐analysis of optimal timing of coronary intervention in non‐ST‐elevation acute coronary syndrome

2019 ◽  
Vol 95 (2) ◽  
pp. 185-193 ◽  
Author(s):  
Mahmoud Barbarawi ◽  
Babikir Kheiri ◽  
Yazan Zayed ◽  
Owais Barbarawi ◽  
Adam Chahine ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Optimal Timing ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome

scholarly journals Coronary Neutrophil Extracellular Trap Burden and Deoxyribonuclease Activity in ST-Elevation Acute Coronary Syndrome Are Predictors of ST-Segment Resolution and Infarct Size

2015 ◽  
Vol 116 (7) ◽  
pp. 1182-1192 ◽  
Author(s):  
Andreas Mangold ◽  
Sherin Alias ◽  
Thomas Scherz ◽  
Thomas M. Hofbauer ◽  
Johannes Jakowitsch ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Infarct Size ◽  
Neutrophil Extracellular Trap ◽  
Myocardial Infarct Size ◽  
Polymorphonuclear Cells ◽  
Coronary Syndrome ◽  
St Segment ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome ◽  
Deoxyribonuclease Activity

Rationale: Mechanisms of coronary occlusion in ST-elevation acute coronary syndrome are poorly understood. We have previously reported that neutrophil (polymorphonuclear cells [PMNs]) accumulation in culprit lesion site (CLS) thrombus is a predictor of cardiovascular outcomes. Objective: The goal of this study was to characterize PMN activation at the CLS. We examined the relationships between CLS neutrophil extracellular traps (NETs), bacterial components as triggers of NETosis, activity of endogenous deoxyribonuclease, ST-segment resolution, and infarct size. Methods and Results: We analyzed coronary thrombectomies from 111 patients with ST-elevation acute coronary syndrome undergoing primary percutaneous coronary intervention. Thrombi were characterized by immunostaining, flow cytometry, bacterial profiling, and immunometric and enzymatic assays. Compared with femoral PMNs, CLS PMNs were highly activated and formed aggregates with platelets. Nucleosomes, double-stranded DNA, neutrophil elastase, myeloperoxidase, and myeloid-related protein 8/14 were increased in CLS plasma, and NETs contributed to the scaffolds of particulate coronary thrombi. Copy numbers of Streptococcus species correlated positively with dsDNA. Thrombus NET burden correlated positively with infarct size and negatively with ST-segment resolution, whereas CLS deoxyribonuclease activity correlated negatively with infarct size and positively with ST-segment resolution. Recombinant deoxyribonuclease accelerated the lysis of coronary thrombi ex vivo. Conclusions: PMNs are highly activated in ST-elevation acute coronary syndrome and undergo NETosis at the CLS. Coronary NET burden and deoxyribonuclease activity are predictors of ST-segment resolution and myocardial infarct size.

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