scholarly journals Fast assessment and management of chest pain patients without ST-elevation in the pre-hospital gateway (FamouS Triage): ruling out a myocardial infarction at home with the modified HEART score

2017 ◽  
Vol 7 (2) ◽  
pp. 102-110 ◽  
Author(s):  
Maycel Ishak ◽  
Danish Ali ◽  
Marion J Fokkert ◽  
Robbert J Slingerland ◽  
Rudolf T Tolsma ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Troponin T ◽  
St Segment Elevation ◽  
Heart Score ◽  
St Segment ◽  
Highly Sensitive ◽  
Highly Sensitive Troponin ◽  
Pain Patients

Background: The first study of the FamouS Triage project investigates the feasibility of ruling out a myocardial infarction in pre-hospital chest pain patients without electrocardiographic ST-segment elevation by using the modified HEART score at the patient’s home, incorporating only a single highly sensitive troponin T measurement. Methods: A venous blood sample was drawn in the ambulance from 1127 consecutive chest pain patients for measurement of the pre-hospital highly sensitive troponin T levels, in order to establish a pre-hospital HEART score (i.e. the modified HEART score) and evaluate the possibility of triage at the patient’s home. The primary endpoint was the occurrence of a major adverse cardiac event (MACE) i.e. acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting or death within 30 days after initial presentation. Results: Two hundred and six patients (18%) developed a MACE during 30 days of follow-up. Thirty-six per cent of the patients ( n=403) had a low modified HEART score (0–3 points) and none of them developed a MACE during follow-up. Forty-four per cent of the patients ( n=494) had an intermediate modified HEART score (4–6 points) and 18% of them developed a MACE. Twenty per cent of the patients ( n=230) had a high modified HEART score (7–10 points) of which 52% developed a MACE during follow-up. Conclusion: It seems feasible to rule out a myocardial infarction at home in chest pain patients without ST-segment elevation by using the modified HEART score. TRIAL ID: NTR4205. Dutch Trial Register [ http://www.trialregister.nl ]: trial number 4205.

scholarly journals P862 A conservative strategy for a frequently fatal post-myocardial infarction mechanical complication

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J Ferreira ◽  
A Freitas ◽  
J Loureiro ◽  
M Beringuilho ◽  
D Faria ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Chest Pain ◽  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Post Myocardial Infarction ◽  
Conservative Strategy ◽  
St Segment Elevation ◽  
St Segment

Abstract A 88-year-old female was admitted for an anterior ST-segment elevation myocardial infarction (STEMI). Patient had a history of intermittent chest pain for 2 days with worsening on the day of admission. Electrocardiogram (ECG) at admission showed ST-segment elevation on leads from V2 to V6 and leads DI and aVL. Initial observation on the emergency department was described as unremarkable apart from the chest pain. Aspirin and Ticagrelor loading doses were administered and patient underwent emergent coronary angiography, which showed left anterior descendent artery occlusion after the emergence of second diagonal branch. Coronary angioplasty of this lesion was tried, with a total of 3 drug-eluted stents implantation but with no success as in the end there was no reflow of the artery. Patient was then admitted on cardiac intensive care unit, and on observation at that time there was a remarking holosystolic murmur. Transthoracic echocardiogram showed (apart from left ventricle systolic disfunction with akinesia of the apical segments as well as middle segments of the interventricular septum (IVS) and anterior wall) an apical IVS defect with a left to right shunt with a gradient of around 50mmHg evaluated by Doppler, and no signs of right ventricle overload. Case was promptly discussed with cardiothoracic surgery and it was decided that she was not a candidate to urgent surgical intervention. Patient had an initial evolution in Killip class II, and remained hemodynamically stable for the rest of the admission, having no signs of heart failure on discharge at 17 days later. Serial ETTs during admission and at discharge were similar to the evaluation performed at admission. In the meanwhile, during admission, case was discussed in multidisciplinary heart team with cardiothoracic surgery and interventional cardiology. Given the favourable evolution and comorbidities and frailty of the patient it was decided to adopt a conservative strategy with medical follow-up, only considering intervention if there was worsening of heart failure. Until now, with 4 months follow-up, patient remains in New York Heart Association (NYHA) functional class I. Discussion Post-myocardial infarction ventricular septal defect (VSD) is a complication that, regardless of the treatment strategy has a high mortality rate, especially when patient presents in cardiogenic shock. However, when patient is stable and especially when comorbidities imposes a high interventional risk medical treatment can be an option. So far, this is a successful case of a medically managed post-myocardial infarction VSD. Abstract P862 Figure. Ventricular Septal Defect

scholarly journals PEMERIKSAAN CKMB DAN HS-TROPONIN T PADA PASIEN INFARK JANTUNG DENGAN PENINGKATAN SEGMEN NON-ST

2018 ◽  
Vol 20 (2) ◽  
pp. 160
Author(s):  
AK Salim ◽  
M Suryaatmadja ◽  
DA Hanafi
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Troponin T ◽  
Coronary Insufficiency ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Grade Ii ◽  
High Sensitive Troponin

Acute Coronary Syndrome (ACS)1 is a typical chest pain symptom due to ischemic coronary insufficiency caused by blockage of acoronary artery thrombus. There are three different states: Unstable Angina (UA), Non-ST segment Elevation Myocardial Infarction(NSTEMI) and ST segment Elevation Myocardial Infarction (STEMI).1 Cardiac Troponin (cTn) is a myocardial ischemia marker.6 A clinicalcontext is very important for the interpretation of the value of cTn, the increase of cTn is not always due to Acute Myocardial Infarction(AMI). According to a research, a new cTn examination called ‘high sensitive troponin T’ (hs-cTropT) has a higher sensitivity than theprevious generations for the diagnosis of AMI.7 A 60- year- old female patient entered the ER of Cardiovascular Hospital Harapan Kitasuffering from chest pain since the day before. From the examination it seemed that the patient had a risk factor of dyslipidemia. Thelaboratory results showed normal routine hematology, CKMB , renal function, glucose and electrolytes, however, hs - cTropT and lipidprofile were shown above normal. The differential diagnosis of the symptoms shown was: UA/NSTEMI, with Congestive Heart Failure(CHF) grade II and overweight.

Posterior wall myocardial infarction: A case report

2017 ◽  
Vol 70 (1-2) ◽  
pp. 44-47
Author(s):  
Milenko Cankovic ◽  
Snezana Bjelic ◽  
Vladimir Ivanovic ◽  
Anastazija Stojsic-Milosavljevic ◽  
Dalibor Somer ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Case Report ◽  
Chest Pain ◽  
Myocardial Revascularization ◽  
Posterior Wall ◽  
Circumflex Artery ◽  
St Segment Elevation ◽  
Therapeutic Benefits ◽  
St Segment ◽  
Therapeutic Algorithms

Introduction. Acute myocardial infarction is a clinical manifestation of coronary disease which occurs when a blood vessel is narrowed or occluded in such a way that it leads to irreversible myocardial ischemia. ST segment depression in leads V1?V3 on the electrocardiogram points to the anterior wall ischemia, although it is actually ST elevation with posterior wall myocardial infarction. In the absence of clear ST segment elevation, it may be overlooked, leading to different therapeutic algorithms which could significantly affect the outcome. Case report. A 77 year-old female patient was admitted to the Coronary Care Unit due to prolonged chest pain followed by nausea and horizontal ST segment depression on the electrocardiogram in V1?V3 up to 3 mm. ST segment elevation myocardial infarction of the posterior wall was diagnosed, associated with the development of initial cardiogenic shock and ischemic mitral regurgitation. An emergency coronarography was performed as well as primary percutaneous coronary intervention with stent placement in the circumflex artery, the infarct-related artery. Due to a multi-vessel disease, surgical myocardial revascularization was indicated. Conclusion. Posterior wall transmural myocardial infarction is the most common misdiagnosis in the 12 lead electrocardiogram reading. Routine use of additional posterior (lateral) leads in all patients with chest pain has no diagnostic or therapeutic benefits, but it is indicated when posterior or lateral wall infarction is suspected. The use of posterior leads increases the number of diagnosed ST segment elevation myocardial infarctions contributing to better risk assessment, prognosis and survival due to reperfusion therapy.

10-Year Follow-Up of Patients With Everolimus-Eluting Versus Bare-Metal Stents After ST-Segment Elevation Myocardial Infarction

2021 ◽  
Vol 77 (9) ◽  
pp. 1165-1178 ◽  
Author(s):  
Salvatore Brugaletta ◽  
Josep Gomez-Lara ◽  
Luis Ortega-Paz ◽  
Victor Jimenez-Diaz ◽  
Marcelo Jimenez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Bare Metal Stents ◽  
Metal Stents ◽  
Bare Metal ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

scholarly journals Two-year clinical performance of Absorb BVS compared to Xience EES in ST-segment elevation myocardial infarction: a pooled analysis of AIDA and COMPARE-ABSORB trials

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L.S.M Kerkmeijer ◽  
G Chao ◽  
R Tijssen ◽  
T Gori ◽  
R.P Kraak ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Target Lesion ◽  
Pooled Analysis ◽  
St Segment Elevation ◽  
Patient Level ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Absorb Bvs ◽  
Target Lesion Failure

Abstract Introduction Bioresorbable vascular scaffolds (BVS) use appears theoretically attractive in patients presenting with ST-segment elevation myocardial infarction (STEMI) as acute lesions are generally composed of soft plaques, in which optimal BVS deployment and expansion is easier to achieve. Furthermore, those patients are generally younger and would benefit longer from the promise of vascular restoration therapy. Purpose In this patient level pooled analysis of two clinical trials, we evaluated the clinical outcomes of Absorb BVS versus Xience everolimus-eluting stent (EES) in STEMI patients at 2-year follow-up. Methods We performed an individual patient-level pooled analysis of the AIDA and COMPARE-ABSORB trials in which 3515 patient were randomly assigned to Absorb BVS (n=1772) or Xience EES (n=1743). Clinical outcomes in STEMI patients were analyzed by randomized treatment assignment cumulative through 2 years. The primary efficacy outcomes measure was target lesion failure (cardiac death, target-vessel myocardial infarction or target lesion revascularization), and the primary safety outcome measure was device thrombosis at 2-year follow-up. Results 350 (19.8%) STEMI patients were allocated to Absorb BVS versus 328 (18.8%) to Xience EES. The mean age of patient presenting with STEMI was 60 years old, 76.0% were males and 15.3% had diabetes mellitus. At 2-years target lesion failure occurred in 8.4% of BVS STEMI patients and 6.2% of EES STEMI patients (p=0.253). The 2-year rates of cardiac death (2.6% vs 1.6%, p=0.332), TV-MI (4.7% vs 2.5%) and TLR (6.8% vs 4.1%) were not significantly different. The 2-year incidence of definite device thrombosis was 4.7% in Absorb BVS versus 1.8% in Xience EES (p=0.045). Conclusion In the present patient-level pooled analysis of the AIDA and COMPARE-Absorb trials, BVS was associated with increased rates of device thrombosis in STEMI patients compared to Xience EES. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Abbott

Outcomes of nonagenarians with acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Echarte Morales ◽  
P.L Cepas Guillen ◽  
G Caldentey ◽  
E Martinez Gomez ◽  
J Borrego-Rodriguez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk Population ◽  
High Morbidity ◽  
Baseline Characteristic ◽  
Invasive Approach ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
All Cause Mortality

Abstract Background Myocardial infarction (MI) in nonagenarians is associated with high morbidity and mortality. Nonetheless, this population has typically been underrepresented in cardiovascular clinical trials. Objective The aim of this study was to evaluate outcomes of nonagenarian patients presenting with MI who underwent either conservative or invasive management. Methods We retrospectively included all consecutive patients equal to or older than 90yo admitted with non-ST segment elevation (NSTEMI) or ST segment elevation MI (STEMI) in four tertiary care centers between 2005 and 2018. Patients with type 2 myocardial infarction were excluded. We collected patients' baseline characteristic and procedural data. In-hospital and at 1-year follow-up all-cause mortality and major adverse cardiovascular events were assessed. Results 523 patients (mean age 92.6±2 years; 60% females) were analyzed. Overall, 184 patients (35.2%) underwent percutaneous coronary intervention (PCI), increasing over the years, mostly in STEMI group (from 16% of patients in 2005 to 75% in 2018). PCI was preferred in those subjects with less prevalence of disability for activities of daily living (p<0.01). The use of a radial access (76.6%) and bare metal stents (52.7%) was predominant. No significant differences were found in the incidence of major bleeding events or MI-related mechanical complications between both strategies. During index hospitalization, 99 (18.9%) patients died. Whereas no differences were found in the NSTEMI group (p=0.61), a significant lower in-hospital mortality was observed in STEMI group treated with PCI (p<0.01). At one-year follow up, 203 (38.8%) patients died, most of them due to a cardiovascular cause (60.6%). PCI was related to a lower all-cause mortality in either NSTEMI (p<0.01) or STEMI groups (p<0.01) however, lower cardiovascular mortality was only found in STEMI group (p=0.03). Conclusion An invasive approach was performed in over a third of nonagenarian patients, carrying prognostic implications and with a few numbers of complications. PCI seems to be the preferred strategy for STEMI in this high-risk population in spite of age. Figure 1 Funding Acknowledgement Type of funding source: None

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