scholarly journals Clinical outcomes of fibrinolytic therapy for prehospital treatment of acute myocardial infarction

2021 ◽  
Vol 37 ◽  
pp. e37071
Author(s):  
Priscila Fernandes Meireles Câmara ◽  
Marcos Antonio Ferreira Júnior ◽  
Allyne Fortes Vitor ◽  
Oleci Pereira Frota ◽  
Viviane Euzébia Pereira Santos ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Clinical Outcomes ◽  
Clinical Improvement ◽  
Prehospital Care ◽  
Signs And Symptoms ◽  
Fibrinolytic Therapy ◽  
Chest Discomfort ◽  
Prehospital Treatment

Fibrinolytic Therapy (FT) is an important form of treatment for cases of Acute Myocardial Infarction (AMI), especially in those places where Primary Percutaneous Coronary Intervention (PPCI) is not available, which is the main form of treatment and can be used even in the prehospital care. Aimed to describe the clinical outcomes of the use of FT in prehospital care for treating patients with AMI. This research covered a total of 53 patients and was carried out from march to october 2017, referring to the care provided from january 2015 to december 2016 in two stages, in which the first occurred with the Mobile Emergency Service (SAMU) and Walk-in Emergency Care Units (UPA), and the second in the referenced hospital services as gateways to those units. Data were collected from secondary sources. The clinical outcomes of FT considered in the form of absolute and relative frequencies and measures of central tendency were considered. The main signs and symptoms at admission were chest pain (84.62%), sweating (36.54%), dyspnea (26.92%), hypertension (19.23%), nausea (17.31%), malaise (17.31%) and emesis (13.46%). The main characteristic of chest discomfort was chest pain (70.45%). The FT drug administered in all patients was tenecteplase. The median time from symptom-to-door was 180 minutes, while symptom-reperfusion was 300 minutes and door-to-needle 160 minutes. Regarding the outcome, 74.47% had clinical improvement, 19.15% died, 4.25% had refractory AMI and 2.13% had reinfarction. The main characteristic of clinical improvement was the reversal of chest pain (68.57%), characterized as myocardial reperfusion criteria. The present study presented the main outcomes of FT use with improvement of those patients who were treated with it, and shorter times related to chest discomfort and the administration of FT were responsible for increasing the outcomes of clinical improvement and decreasing the outcome of death.

scholarly journals Clinical Impact of Atypical Chest Pain and Diabetes Mellitus in Patients with Acute Myocardial Infarction from Prospective KAMIR-NIH Registry

2020 ◽  
Vol 9 (2) ◽  
pp. 505
Author(s):  
Jun-Won Lee ◽  
Jin Sil Moon ◽  
Dae Ryong Kang ◽  
Sang Jun Lee ◽  
Jung-Woo Son ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Clinical Outcomes ◽  
Composite Endpoint ◽  
Clinical Impact ◽  
Atypical Chest Pain ◽  
Delayed Treatment ◽  
Adjusted Model

Atypical chest pain and diabetic autonomic neuropathy attract less clinical attention, leading to underdiagnosis and delayed treatment. To evaluate the long-term clinical impact of atypical chest pain and diabetes mellitus (DM), we categorized 11,159 patients with acute myocardial infarction (AMI) from the Korea AMI-National Institutes of Health between November 2011 and December 2015 into four groups (atypical DM, atypical non-DM, typical DM, and typical non-DM). The primary endpoint was defined as patient-oriented composite endpoint (POCE) at 2 years including all-cause death, any myocardial infarction (MI), and any revascularization. Patients with atypical chest pain showed higher 2-year mortality than those with typical chest pain in both DM (29.5% vs. 11.4%, p < 0.0001) and non-DM (20.4% vs. 6.3%, p < 0.0001) groups. The atypical DM group had the highest risks of POCE (hazard ratio (HR) 1.76, 95% confidence interval (CI) 1.48–2.10), all-cause death (HR 2.23, 95% CI 1.80–2.76) and any MI (HR 2.34, 95% CI 1.51–3.64) in the adjusted model. In conclusion, atypical chest pain was significantly associated with mortality in patients with AMI. Among four groups, the atypical DM group showed the worst clinical outcomes at 2 years. Application of rapid rule in/out AMI protocols would be beneficial to improve clinical outcomes.

scholarly journals Sinais, sintomas e complicações do infarto agudo do miocárdio

2018 ◽  
Vol 12 (1) ◽  
pp. 247 ◽  
Author(s):  
Renata Soares Passinho ◽  
Cândida Caniçali Primo ◽  
Walckiria Garcia Romero Sipolatti ◽  
Mirian Fioresi
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Nursing Care ◽  
Early Recognition ◽  
Signs And Symptoms ◽  
Nursing Diagnosis ◽  
Affected Person ◽  
Insuficiencia Cardiaca ◽  
Care Nursing

RESUMOObjetivo: analisar as produções científicas a respeito da frequência dos sinais, sintomas e complicações do infarto agudo do miocárdio. Método: revisão integrativa, com busca publicações entre 2010 a 2014 nas bases de dados LILACS, MEDLINE e CINAHL. O processo de análise dos 122 artigos selecionados deu-se por meio da leitura exploratória e crítica dos títulos, resumos e dos resultados das pesquisas, onde se buscaram os fenômenos relacionados ao IAM (sinais, sintomas e complicações). Resultados: A dor no peito (N = 75), a insuficiência cardíaca (N = 52), a dispneia (N= 24) e a arritmia (N= 20) foram os sinais e sintomas mais encontrados. Conclusão: a dor no peito é o sintoma mais frequente da doença. O reconhecimento precoce desses fenômenos irá contribuir para a melhoria do prognóstico da pessoa acometida. Descritores: Cuidados de Enfermagem; Diagnóstico de Enfermagem; Infarto Agudo do Miocárdio; Classificação; Enfermeiras e Enfermeiros; Cardiologia.ABSTRACTObjective: to analyze the scientific productions regarding the frequency of signs, symptoms and complications of acute myocardial infarction. Method: integrative review, with search publications between 2010 to 2014, in the databases LILACS, MEDLINE and CINAHL. The process of analysis of the 122 articles selected was based on the exploratory and critical reading of the titles, abstracts and results of the research, in which the AMI-related phenomena (signs, symptoms and complications) were searched. Results: chest pain (N = 75), heart failure (N = 52), dyspnea (N = 24) and arrhythmia (N = 20) were the most common signs and symptoms. Conclusion: chest pain is the most frequent symptom of the disease. The early recognition of these phenomena will contribute to the improvement of the prognosis of the affected person. Descriptors: Nursing Care; Nursing diagnosis; Acute Myocardial Infarction; Classification; Nurses and Nurses; Cardiology.RESUMENObjetivo: analizar las producciones científicas acerca de la frecuencia de los signos, síntomas y complicaciones del infarto agudo de miocardio. Método: revisión integrativa, con búsqueda publicaciones entre 2010 a 2014, en las bases de datos LILACS, MEDLINE y CINAHL. El proceso de análisis de los 122 artículos seleccionados se dio por medio de la lectura exploratoria y crítica de los títulos, resúmenes y de los resultados de las investigaciones, donde se buscaron los fenómenos relacionados al IAM (signos, síntomas y complicaciones). Resultados: el dolor en el pecho (N = 75), la insuficiencia cardiaca (N = 52), la disnea (N = 24) y la arritmia (N = 20) fueron los signos y síntomas más encontrados. Conclusión: el dolor en el pecho es el síntoma más frecuente de la enfermedad. El reconocimiento precoz de estos fenómenos contribuirá a la mejora del pronóstico de la persona acometida. Descriptores: Cuidados de Enfermería; Diagnóstico de Enfermería; Infarto Agudo de Miocardio; Clasificación; Enfermeras y Enfermeras; Cardiología.

scholarly journals Chart review of acute myocardial infarction at a district hospital in KwaZulu-Natal, South Africa

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Roland Chetty ◽  
Andrew Ross
Keyword(s):  
Myocardial Infarction ◽  
South Africa ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Chart Review ◽  
District Hospital ◽  
Asian Population ◽  
Fibrinolytic Therapy ◽  
Junior Staff ◽  
Kwazulu Natal

Background: Incidence and prevalence of non-communicable diseases, including ischaemic heart disease (IHD) and associated acute myocardial infarction (AMI), are increasing in South Africa. Local studies are needed as contextual factors, such as healthcare systems, gender and ethnicity, may affect presentation and management. In AMI, reviews on time between onset of chest pain and initiation of urgent treatment are useful, as delays in initiation of thrombolytic treatment significantly increase morbidity and mortality.Aim: The aim of the study was to determine the profile and management of patients admitted with ischaemic chest pain.Setting: The study was carried out in a busy urban-based district hospital in KwaZulu-Natal, South Africa. The population served is poor, and patients are mainly Indian with associated high risk of IHD.Methods: A chart review of all patients seen at the hospital with acute ischaemic chest pain between 01 March and 31 August 2014 was undertaken.Results: More male than female patients were admitted, with a wide variation in age. Most eligible patients received required thrombolytic intervention within an acceptable time period after arrival at hospital.Conclusion: Chest pain and AMI were a relatively common presentation at the study site, and urgent diagnosis and initiation of fibrinolytic therapy are essential. The encouraging door-toneedle time may have been influenced by the availability of specialist family physicians, trained as ‘expert generalists’ to provide appropriate care in a variety of settings and consultant support to junior staff. The role of the family physician and primary healthcare doctor in primary prevention are re-emphasised through the study findings.Keywords: Acute myocardial infarction; KwaZulu-Natal; district hospital; Asian population; hospital chart review; door-to-needle-time

Impact of gender on angiographic and clinical outcomes after fibrinolytic therapy in acute myocardial infarction

2002 ◽  
Vol 90 (7) ◽  
pp. 766-770 ◽  
Author(s):  
Sabina A Murphy ◽  
Christopher Chen ◽  
Christopher P Cannon ◽  
Elliott M Antman ◽  
C.Michael Gibson
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Clinical Outcomes ◽  
Fibrinolytic Therapy

scholarly journals Effects of stent generation on clinical outcomes after acute myocardial infarction compared between prediabetes and diabetes patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yong Hoon Kim ◽  
Ae-Young Her ◽  
Myung Ho Jeong ◽  
Byeong-Keuk Kim ◽  
Sung-Jin Hong ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Clinical Outcomes ◽  
Secondary Outcome ◽  
Drug Eluting Stent ◽  
Diabetes Group ◽  
Repeat Revascularization ◽  
Group A ◽  
Group B ◽  
Diabetes Patients

AbstractWe investigated the effects of stent generation on 2-year clinical outcomes between prediabetes and diabetes patients after acute myocardial infarction (AMI). A total of 13,895 AMI patients were classified into normoglycemia (group A: 3673), prediabetes (group B: 5205), and diabetes (group C: 5017). Thereafter, all three groups were further divided into first-generation (1G)-drug-eluting stent (DES) and second-generation (2G)-DES groups. Patient-oriented composite outcomes (POCOs) defined as all-cause death, recurrent myocardial infarction (Re-MI), and any repeat revascularization were the primary outcome. Stent thrombosis (ST) was the secondary outcome. In both prediabetes and diabetes groups, the cumulative incidences of POCOs, any repeat revascularization, and ST were higher in the 1G-DES than that in the 2G-DES. In the diabetes group, all-cause death and cardiac death rates were higher in the 1G-DES than that in the 2G-DES. In both stent generations, the cumulative incidence of POCOs was similar between the prediabetes and diabetes groups. However, in the 2G-DES group, the cumulative incidences of Re-MI and all-cause death or MI were significantly higher in the diabetes group than that in the prediabetes group. To conclude, 2G-DES was more effective than 1G-DES in reducing the primary and secondary outcomes for both prediabetes and diabetes groups.

scholarly journals Diagnostic markers for discriminating between acute aortic dissection and acute myocardial infarction during the pre-hospital phase: analysis of 3,195 cases

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Watanabe ◽  
H Yoshino ◽  
T Takahashi ◽  
M Usui ◽  
K Akutsu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Back Pain ◽  
Chest Pain ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Diagnostic Markers ◽  
Network Database ◽  
History Of ◽  
First Contact

Abstract   Both acute aortic dissection (AAD) and acute myocardial infarction (AMI) present with chest pain and are life-threatening diseases that require early diagnosis and treatment for better clinical outcome. However, two critical diseases in the very acute phase are sometimes difficult to differentiate, especially prior to arrival at the hospital for urgent diagnosis and selection of specific treatment. The aim of our study was to clarify the diagnostic markers acquired from the information gathered from medical history taking and physical examination for discriminating AAD from AMI by using data from the Tokyo Cardiovascular Care Unit (CCU) Network database. We examined the clinical features and laboratory data of patients with AAD and AMI who were admitted to the hospital in Tokyo between January 2013 and December 2015 by using the Tokyo CCU Network database. The Tokyo CCU Network consists of &gt;60 hospitals that fulfil certain clinical criteria and receive patients from ambulance units coordinated by the Tokyo Fire Department. Of 15,061 patients diagnosed as having AAD and AMI, 3,195 with chest pain within 2 hours after symptom onset (537 AAD and 2,658 AMI) were examined. The patients with out-of-hospital cardiac arrest were excluded. We compared the clinical data of the patients with chest pain who were diagnosed as having AAD and AMI. The following indicators were more frequent or had higher values among those with AAD: female sex (38% vs. 20%, P&lt;0.001), systolic blood pressures (SBPs) at the time of first contact by the emergency crew (142 mmHg vs. 127 mmHg), back pain in addition to chest pain (54% vs. 5%, P&lt;0.001), history of hypertension (73% vs. 58%, P&lt;0.001), SBP ≥150 mmHg (39% vs. 22%, P&lt;0.001), back pain combined with SBP ≥150 mmHg (23% vs. 0.8%, P&lt;0.001), and back pain with SBP &lt;90 mmHg (4.5% vs. 0.1%, P&lt;0.001). The following data were less frequently observed among those with AAD: diabetes mellitus (7% vs. 28%, P&lt;0.001), dyslipidaemia (17% vs. 42%, P&lt;0.001), and history of smoking (48% vs. 61%, P&lt;0.001). The multivariate regression analysis suggested that back pain with SBP ≥150 mmHg (odds ratio [OR] 47; 95% confidence interval [CI] 28–77; P&lt;0.001), back pain with SBP &lt;90 mmHg (OR 68, 95% CI 16–297, P&lt;0.001), and history of smoking (OR 0.49, 95% CI 0.38–0.63, P&lt;0.001) were the independent markers of AAD. The sensitivity and specificity of back pain with SBPs of ≥150 mmHg and back pain with SBPs &lt;90 mmHg for detecting AAD were 23% and 99%, and 4% and 99%, respectively. In patients with chest pain suspicious of AAD and AMI, “back pain accompanied by chest pain with SBP ≥150 mmHg” or “back pain accompanied by chest pain with SBP &lt;90 mmH” is a reliable diagnostic marker of AAD with high specificity, although the sensitivity was low. The two SBP values with back pain are markers that may be useful for the ambulance crew at their first contact with patients with chest pain. Funding Acknowledgement Type of funding source: None

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