Abstract P444: Myocardial Infarction and Subarachnoid Hemorrhage. Frequency and Impact on Outcome

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Mohammad Rauf Chaudhry ◽  
Hussan Gill ◽  
Saqib Chaudhry ◽  
Baljinder Singh ◽  
Harathi Bandaru ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Subarachnoid Hemorrhage ◽  
Fold Increase ◽  
Severe Disability ◽  
Hospital Charges ◽  
Neurogenic Pulmonary Edema ◽  
Systemic Complications ◽  
International Classification Of Disease ◽  
Myocardial Infraction ◽  
Increase Risk

Introduction/background: Subarachnoid hemorrhage is known to be associated with systemic complications including neurogenic pulmonary edema and Talkotsubo cardiomyopathy. We set to establish the frequency of myocardial infarction (MI) and its impact on outcome among patients with subarachnoid hemorrhage (SAH) Methods: We analyzed the data from Nationwide Inpatient Sample (2005-2014) for all subarachnoid hemorrhage (ICH) patients. Myocardial infraction (MI) was identified using the International Classification of Disease, 9th Revision, Clinical Modification codes. Baseline characteristics, discharge outcomes (mortality, moderate to severe disability at dischagre, length of stay and in-hospital charges) were compared between the two groups. Results: Of the 325923 patients with SAH, 12720 (3.90%) had in-hospital myocardial infraction. SAH patients with MI were older (64.6 years versus 59.0 years, P <.0001) compared to SAH patients without MI but there was no difference in-term of proportion of females between the two groups. The in-hospital mortality was also higher (49.8% versus 23.9%, p≤.0001) among patients with MI in both univariate and multivariate analysis (OR = 1.75 (1.59 -1.93), P<.0001) after adjusting for potential confounders. SAH patients with MI had higher (68.5% versus 40.9%, P <.0001) proportion of moderate to severe disability at discharge compared to ones without. Similarly, mean length of in-hospital stay (13.2 days versus 11.8 days, P <.0001) and mean hospital charges ($188845 versus $150062, P <.0001) were also higher in SAH patients with MI Conclusions: While MI was reported in only 3.9% of SAH cases it had a significant impact on outcome with a one fold increase in morality and about 75% increase risk of severe disability.

Abstract P456: Myocardial Infarction in Patients With Intracerebral Hemorrhage. Prevalence and Impact on Outcome

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Mohammad Rauf Chaudhry ◽  
Hussan Gill ◽  
Saqib Chaudhry ◽  
Baljinder Singh ◽  
Harathi Bandaru ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Intracerebral Hemorrhage ◽  
Nationwide Inpatient Sample ◽  
Hospital Charges ◽  
Discharge Disposition ◽  
International Classification Of Disease ◽  
Myocardial Infraction ◽  
Discharge Outcomes ◽  
Baseline Characteristics

Introduction/background: Comorbidities can potentially affect outcome of patients with intracerebral hemorrhage (ICH). It is unclear what the prevalence of acute myocardial infarction (AMI) and its impact on outcome are in patients with intracerebral hemorrhage. Methods: We analyzed the data from Nationwide Inpatient Sample (2005-2014) for all intracerebral hemorrhage (ICH) patients. AMI was identified using the International Classification of Disease, 9th Revision, Clinical Modification codes. Baseline characteristics, discharge outcomes (mortality, discharge disposition, length of stay and in-hospital charges) were compared between the two groups. Results: Of the 884379 patients with ICH, 27692 (3.13%) had in-hospital myocardial infraction. ICH patients with AMI order had lower proportion of females (47.8% versus 49.7%, P= 0.0028) and were older (69.7 years versus 67.2 years, P <.0001) compared to ICH patients without MI. The in-hospital mortality was higher (40.9% versus 25.5%, p≤.0001) among ICH patients with AMI in both univariate and multivariate analysis (OR = 1.22 (1.14 -1.31), P<.0001) after adjusting for potential confounders. ICH patients with MI had higher (72.4% versus 58.8%, P <.0001) proportion of moderate to severe disability at discharge compared to ones without. Similarly, mean length of in-hospital stay (12.4 days versus 8.94 days, P <.0001) and mean hospital charges ($129328 versus $ 81984.0, P <.0001) were also higher in ICH patients with MI Conclusions: While only 3.13% of patients with ICH have an AMI, there is a 22% increase in worse outcome among those patients with AMI and ICH.

Subarachnoid Hemorrhage

2016 ◽  
Author(s):  
Imoigele P Aisiku
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Delayed Cerebral Ischemia ◽  
Three Dimensional ◽  
Aneurysm Rupture ◽  
World Federation ◽  
Neurogenic Pulmonary Edema ◽  
Systemic Complications ◽  
Unruptured Aneurysms ◽  
Risk Of Rupture ◽  
Anterior Communicating Aneurysm

Subarachnoid hemorrhage (SAH) represents a small portion of cerebrovascular disease but a disproportionally large percentage of the morbidity and mortality. The overall prognosis depends on the volume of the initial bleeding, rebleeding, and the degree of delayed cerebral ischemia. The presence of cardiac manifestations and neurogenic pulmonary edema at the initial presentation indicates a higher degree of severity and systemic complications. This review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of SAH. Figures show common saccular aneurysm locations, a noncontrast head computed tomographic scan of an SAH, an angiogram and surgical clipping of a broad-based anterior communicating aneurysm, and a three-dimensional reconstruction angiogram of a complex anterior communicating aneurysm with additional imaging of endoscopic stent-assisted coiling of the same aneurysm. Tables list the natural history of unruptured aneurysms and the annual risk of rupture, common clinical features and syndromes related to aneurysm location, the World Federation of Neurologic Surgeons grading system, the Hunt and Hess grading systems, and the Fisher scale. This review contains 4 highly rendered figures, 5 tables, and 144 references. Key words: aneurysm rupture, cerebral aneurysm, cerebral vasospasm, Fisher scale, Glasgow Coma Scale assessment, Hunt and Hess grading criteria, subarachnoid hemorrhage, World Federation of Neurologic Surgeons grading scale 

Subarachnoid Hemorrhage

2016 ◽  
Author(s):  
Imoigele P Aisiku
Keyword(s):  
Blood Pressure ◽  
Subarachnoid Hemorrhage ◽  
Delayed Cerebral Ischemia ◽  
Aneurysm Rupture ◽  
World Federation ◽  
Neurogenic Pulmonary Edema ◽  
Surgical Clipping ◽  
Systemic Complications ◽  
Risk Of Rupture ◽  
Anterior Communicating Aneurysm

Subarachnoid hemorrhage (SAH) represents a small portion of cerebrovascular disease but a disproportionally large percentage of the morbidity and mortality. The overall prognosis depends on the volume of the initial bleeding, rebleeding, and the degree of delayed cerebral ischemia. The presence of cardiac manifestations and neurogenic pulmonary edema at the initial presentation indicates a higher degree of severity and systemic complications. This review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of SAH. Figures show common saccular aneurysm locations, a noncontrast head computed tomographic scan of an SAH, an angiogram and surgical clipping of a broad-based anterior communicating aneurysm, and a three-dimensional reconstruction angiogram of a complex anterior communicating aneurysm with additional imaging of endoscopic stent-assisted coiling of the same aneurysm. Tables list the natural history of unruptured aneurysms and the annual risk of rupture, common clinical features and syndromes related to aneurysm location, the World Federation of Neurologic Surgeons grading system, the Hunt and Hess grading systems, and the Fisher scale. This review contains 4 highly rendered figures, 5 tables, and 144 references. Key words: aneurysm rupture, cerebral aneurysm, cerebral vasospasm, Fisher scale, Glasgow Coma Scale assessment, Hunt and Hess grading criteria, subarachnoid hemorrhage, World Federation of Neurologic Surgeons grading scale  Key Advances CT angiography is an emerging technology that has the diagnostic advantage of being non-invasive.  The diagnostic accuracy of CTA varies widely and when compared to the standard digital subtraction angiography (DSA) the sensitivity and specificity range from 77% to 100% and 87%-100% respectively. The 2012 AHA guidelines and the 2011 Neurocritical care society (NCS) consensus guidelines recommend that from the time of symptom onset to securing of the aneurysm, the blood pressure be controlled with a titratable agent with a goal systolic blood pressure of less than 160mmHg or a MAP of less than 110mmHg. Cardiac abnormalities are common following acute SAH.  Subendocardial ischemia may result from autonomic stimulation from the brain and circulating catecholamine surge, resulting in an abnormal ECG in 50% to 100% of patients with SAH in the acute phase depending on severity. The International Subarachnoid Aneurysm Trial ISAT was a landmark study that looked at aSAH repair comparing surgical clipping with endoscopic coiling and demonstrated a mortality benefit with coiling in the right patient population.

Alanine Aminotransferase Predicts Outcomes in Elderly Patients with Aneurysmal Subarachnoid Hemorrhage

2019 ◽  
Vol 16 (1) ◽  
pp. 89-95
Author(s):  
Jianfeng Zheng ◽  
Rui Xu ◽  
Zongduo Guo ◽  
Xiaochuan Sun
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Elderly Patients ◽  
Clinical Outcomes ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Laboratory Data ◽  
Cardiac Complications ◽  
World Population ◽  
Systemic Complications ◽  
Poor Outcome ◽  
Poor Outcomes

Objective: With the aging of the world population, the number of elderly patients suffering from aneurysmal subarachnoid hemorrhage (aSAH) is gradually growing. We aim to investigate the potential association between plasma ALT level and clinical complications of elderly aSAH patients, and explore its predictive value for clinical outcomes of elderly aSAH patients. Methods: Between January 2013 and March 2018, 152 elderly aSAH patients were analyzed in this study. Clinical information, imaging findings and laboratory data were reviewed. According to the Glasgow Outcome Scale (GOS), clinical outcomes at 3 months were classified into favorable outcomes (GOS 4-5) and poor outcomes (GOS 1-3). Logistic regression analysis was used to assess the indicators associated with poor outcomes, and receiver curves (ROC) and corresponding area under the curve (AUC) were used to detect the accuracy of the indicator. Results: A total of 48 (31.6 %) elderly patients with aSAH had poor outcome at 3 months. In addition to ICH, IVH, Hunt-Hess 4 or 5 Grade and Modified Fisher 3 or 4 Grade, plasma ALT level was also strongly associated with poor outcome of elderly aSAH patients. After adjusting for other covariates, plasma ALT level remained independently associated with pulmonary infection (OR 1.05; 95% CI 1.00–1.09; P = 0.018), cardiac complications (OR 1.05; 95% CI 1.01–1.08; P = 0.014) and urinary infection (OR 1.04; 95% CI 1.00–1.08; P = 0.032). Besides, plasma ALT level had a predictive ability in the occurrence of systemic complications (AUC 0.676; 95% CI: 0.586– 0.766; P<0.001) and poor outcome (AUC 0.689; 95% CI: 0.605–0.773; P<0.001) in elderly aSAH patients. Conclusion: Plasma ALT level of elderly patients with aSAH was significantly associated with systemic complications, and had additional clinical value in predicting outcomes. Given that plasma ALT levels on admission could help to identify high-risk elderly patients with aSAH, these findings are of clinical relevance.

Calcium supplements increase risk of myocardial infarction

2010 ◽  
Vol 15 (6) ◽  
pp. 181-181 ◽  
Author(s):  
S. Singh ◽  
C. D. Furberg
Keyword(s):  
Myocardial Infarction ◽  
Calcium Supplements ◽  
Increase Risk

Abstract P372: Evaluation of International Classification of Disease-Ninth Edition (ICD-9) codes for Determining Subclasses and Anatomic Location of Myocardial Infarction in the Community

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Wayne D Rosamond ◽  
Rachel Kloss ◽  
Natalia Petruski-ivleva ◽  
Lisa Wruck ◽  
Erin Michos ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Biomarkers ◽  
General Category ◽  
Atherosclerosis Risk In Communities ◽  
International Classification Of Disease ◽  
Anatomic Location ◽  
St Segment ◽  
Definition Of ◽  
Anatomic Locations ◽  
Epidemiology Studies

Background: Epidemiology studies of acute myocardial infarction (MI) often rely on hospital discharge codes or claims data to identify events. The fourth digit of ICD-9 code 410 is meant to identify anatomic location of an MI. Although the validity of ICD-9 410 codes to identify the general category of MI has been studied, far less is known about the validity of ICD codes to identify ST segment MI (STEMI) and non-STEMI (NSTEMI) and to identify anatomic location of STEMI infarcts. Methods: From 1987 to 2010 we evaluated random samples of hospitalizations with ICD-9 discharge codes 410-414, 402, 427, 428, or 518.4 among men and women age 35-74 years from hospitals serving the 4 communities of the Atherosclerosis Risk in Communities (ARIC) Study (400,000 base population in 2010). Trained staff abstracted medical records and copied up to three 12-lead electrocardiograms (ECG) that were coded by Minnesota Code. A standardized algorithm was applied to data on chest pain, cardiac biomarkers, and ECG evidence to determine MI diagnosis. Validated MI events with abnormal biomarkers were further classified by ECGs as STEMI or NSTEMI. ICD-9 codes 410.0-410.6 and 410.8 were used to define STEMI while codes 410.7 or 410.9 defined NSTEMI. STEMI infarct location was assessed by ECG and categorized as anterior, inferior, lateral, or multi-location. We determined the validity of code-based definitions using the ARIC algorithm and ECG evidence as referent standards. All analyses were weighted to account for sampling. Results: Between 1987 and 2010, 208,920 (weighted) hospitalizations with discharge codes suggestive of MI occurred in the 4 ARIC communities. Of these, 19% (38,729/208,920) were validated as MI. The positive predictive value (PPV) of an ICD-9 410 code to identify a validated MI was 72% (22218/30652). This PPV declined slightly from 78% (862/1111) in 1987 to 71% (1031/1462) in 2010. Center differences by community were seen (range 63% (197/315) to 78% (173/222) in 2010). Sensitivity of a 410 code to identify validated MIs remained stable from 1987 to 2010 at about 57% (22218/38,729). The PPV of the ICD-9 code-based STEMI definition improved after 2005 but remained moderate at 41% (175/430) in 2010. The PPV of the ICD-9 code based definition of NSTEMI was 63% (599/945) in 2010 and was stable over time. The PPV of codes to identify anterior and inferior infarctions were high (66% (1145/1741) and 78% (1956/2518), respectively). However codes for lateral and multiple site infarctions had lower PPV (53% (327/619) and 21% (153/727), respectively). Conclusions: The PPV of an ICD-9 code 410 to identify MI remained stable over the past 2 decades, but geographic differences persist. ICD-9 codes are better at correctly identifying NSTEMI than STEMI and better at identifying inferior infarcts than other anatomic locations. These data suggest caution in interpreting studies of MI trends based solely on ICD-9 codes.

scholarly journals Neurogenic Pulmonary Edema and Large Negative T Waves Associated with Subarachnoid Hemorrhage.

2001 ◽  
Vol 40 (8) ◽  
pp. 826-828 ◽  
Author(s):  
Masafumi TAKAHASHI ◽  
Takeshi MITSUHASHI ◽  
Takaaki KATSUKI ◽  
Uichi IKEDA ◽  
Hidenobu TANAKA ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Pulmonary Edema ◽  
Neurogenic Pulmonary Edema ◽  
T Waves

scholarly journals Cyanobacteria as Nanogold Factories II: Chemical Reactivity and anti-Myocardial Infraction Properties of Customized Gold Nanoparticles Biosynthesized by Cyanothece sp.

Marine Drugs ◽  
2019 ◽  
Vol 17 (7) ◽  
pp. 402 ◽  
Author(s):  
Nancy S. Younis ◽  
Esam M. Bakir ◽  
Maged E. Mohamed ◽  
Nermin A. El Semary
Keyword(s):  
Myocardial Infarction ◽  
Gold Nanoparticles ◽  
Chemical Reactivity ◽  
Characteristic Absorption Band ◽  
Novel Approach ◽  
Myocardial Infraction ◽  
Metal State ◽  
Chemical Conditions ◽  
Physiological And Biochemical ◽  
Successful Production

Cyanothece sp., a coccoid, unicellular, nitrogen-fixing and hydrogen-producing cyanobacterium, has been used in this study to biosynthesize customized gold nanoparticles under certain chemical conditions. The produced gold nanoparticles had a characteristic absorption band at 525–535 nm. Two types of gold nanoparticle, the purple and blue, were formed according to the chemical environment in which the cyanobacterium was grown. Dynamic light scattering was implemented to estimate the size of the purple and blue nanoparticles, which ranged from 80 ± 30 nm and 129 ± 40 nm in diameter, respectively. The highest scattering of laser light was recorded for the blue gold nanoparticles, which was possibly due to their larger size and higher concentration. The appearance of anodic and cathodic peaks in cyclic voltammetric scans of the blue gold nanoparticles reflected the oxidation into gold oxide, followed by the subsequent reduction into the nano metal state. The two produced forms of gold nanoparticles were used to treat isoproterenol-induced myocardial infarction in experimental rats. Both forms of nanoparticles ameliorated myocardial infarction injury, with a slight difference in their curative activity with the purple being more effective. Mechanisms that might explain the curative effect of these nanoparticles on the myocardial infarction were proposed. The morphological, physiological, and biochemical attributes of the Cyanothece sp. cyanobacterium were fundamental for the successful production of “tailored” nanoparticles, and complemented the chemical conditions for the differential biosynthesis process. The present research represents a novel approach to manipulate cyanobacterial cells towards the production of different-sized gold nanoparticles whose curative impacts vary accordingly. This is the first report on that type of manipulated gold nanoparticles biosynthesis which will hopefully open doors for further investigations and biotechnological applications.

scholarly journals Quantitative and qualitative composition of the innate immune response are equally important in wound healing after myocardial infarction

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J Wrobel ◽  
J Rettkowski ◽  
H Seung ◽  
C Wadle ◽  
P Stachon ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cell Cycle ◽  
Wound Healing ◽  
Innate Immunity ◽  
Cardiac Function ◽  
Ventricular Remodeling ◽  
Myeloid Cells ◽  
Fold Increase ◽  
Remote Myocardium ◽  
Inflammatory Phenotype

Abstract Background Emergency hematopoiesis (EH) serves as the foundation of monocyte-derived and macrophage (Mφ) driven efferocytosis and ventricular remodeling after myocardial infarction (MI). Excessive myelopoiesis, however, can stipulate maladaptive wound healing and its therapeutic reduction may be a novel approach to preserve cardiac function. All-trans retinoic acid (ATRA) is a pleiotropic modulator of EH and innate immunity shielding hematopoietic stem cells from activation and driving survival and differentiation of myeloid cells. Purpose This study aimed to investigate this intriguing interplay of ATRA in wound healing after MI. Methods MI was induced by permanent coronary ligation in C57BL/6 mice and treated with daily injections of either ATRA (30mg/kg) or DMSO (vehicle) up to five days, starting 24h after ligation. Flow cytometry (FACS) was used for cell cycle analysis and immunophenotyping of leukocytes in bone marrow (BM), blood and heart. Immunohistochemistry (IH), masson trichrome (MT) staining and echocardiography evaluated inflammatory-fibrotic and functional development. Cytokine expression was analyzed by qPCR in bulk infarct and isolated, polarized Mφ-populations of BM-derived and cardiac resident origin. Results On day 2 after MI, EH was significantly reduced in ATRA-treated mice as compared to vehicle controls by means of cell cycle activity (n=6–13 per group; p&lt;0,01) and myeloid cells in BM, blood and infarct tissue (n=5–13; p&lt;0,05). Consequently, mRNA-expression of key inflammatory cytokines, IL-1β and TNFα, was diminished in the infarct tissue in this early phase (n=5–12; p&lt;0,05). These changes, however, failed to preserve cardiac function and ventricular remodeling, 21 days after MI (n=10–11; not significant). By qPCR, non-canonical activation of recruited ATRA-primed monocyte-derived Mφ, was found to propagate a pro-inflammatory phenotype with higher expression of MMP2 and MMP9 in sorted cardiac Mφ (n=4–5; p&lt;0,001). Furthermore, prominent IL-1β-expression in M2-polarized BM-derived Mφ indicated an impaired anti-inflammatory phenotype after ATRA treatment (n=4–6; p&lt;0,05). Strikingly, these changes also occurred in remote myocardium where IH revealed a 2-fold increase of CD11b - positive myeloid cells accompanied by increased expression of TNFα and TGFβ (n=9; p&lt;0,001). MT-staining, performed 21 days after MI, demonstrated an almost 3-fold increase in collagen deposition in remote myocardium of ATRA treated mice in contrast to vehicle controls (n=4–6; p&lt;0,0001). Conclusion Despite a beneficial reduction of EH after MI, short-term treatment with ATRA induced profound and persisting changes in the cytokine expression of monocyte-derived Mφ, which significantly altered their function and thus prevented improvements in cardiac function. Our data provide evidence that quantitative and qualitative changes in innate immunity are equally important for cardiac remodeling after MI. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Deutsche Forschungsgemeinschaft

scholarly journals PROGNOSTIC IMPORTANCE OF WBC COUNT IN ACUTE MYOCARDIAL INFRACTION

2021 ◽  
Vol 5 (5) ◽  
Author(s):  
Mansa Ram Saran ◽  
Sukh Chain
Keyword(s):  
Myocardial Infarction ◽  
High Rate ◽  
Inclusion Criteria ◽  
Lv Dysfunction ◽  
Myocardial Infraction ◽  
Acute Mi ◽  
Prognostic Importance ◽  
Artery Disease ◽  
Wbc Count ◽  
Global Health Problem

Background: Coronary artery disease is a major cause of death and is a global health problem becoming an epidemic in both developed as well as in developing countries. Methods: 100 patients presenting to hospital within 24hrs with Acute MI and qualifying inclusion criteria were enrolled and written consent was taken regarding participation in the study. Results: In a total of 100 patients participated in our study 69 patients were male and 31 patients were females. Out of 100 patients 26 had LV dysfunction, among these 23 patients 17 were having elevated WBC count and 9 had normal WBC count. Among 100 patients 11 had cardiogenic shock, among these 11 patients 8 had elevated WBC count and 3 had normal WBC count.    Conclusion: Elevated WBC count within 24 hours was associated with high rate of complications after acute myocardial infarction. Keywords: STEMI, NSTEMI, WBC

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