scholarly journals What an Interventionalist Needs to Know About MI with Non-obstructive Coronary Arteries

2021 ◽  
Vol 16 ◽  
Author(s):  
Robert Sykes ◽  
Daniel Doherty ◽  
Kenneth Mangion ◽  
Andrew Morrow ◽  
Colin Berry
Keyword(s):  
Coronary Arteries ◽  
Accurate Diagnosis ◽  
Evidence Based ◽  
Prevention Strategies ◽  
St Segment Elevation ◽  
Diagnostic Pathway ◽  
St Segment ◽  
Acute Mi ◽  
Evidence Based Therapy ◽  
Function Testing

MI with non-obstructive coronary arteries (MINOCA) is caused by a heterogeneous group of vascular or myocardial disorders. MINOCA occurs in 5–15% of patients presenting with acute ST-segment elevation MI or non-ST segment elevation MI and prognosis is impaired. The diagnosis of MINOCA is made during coronary angiography following acute MI, where there is no stenosis ≥50% present in an infarct-related epicardial artery and no overt systemic aetiology for the presentation. Accurate diagnosis and subsequent management require the appropriate utilisation of intravascular imaging, coronary function testing and subsequent imaging to assess for myocardial disorders without coronary involvement. Although plaque-related MINOCA is currently managed with empirical secondary prevention strategies, there remains an unmet therapeutic need for targeted and evidence-based therapy for MINOCA patients and increased awareness of the recommended diagnostic pathway.

scholarly journals Electroangiographic Correlation of Simultaneous ST-Segment Elevations of Anterior and Inferior Segment: Who Is the Culprit?

2021 ◽  
pp. 263246362110155
Author(s):  
Pankaj Jariwala ◽  
Shanehyder Zaidi ◽  
Kartik Jadhav
Keyword(s):  
Myocardial Infarction ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Index Case ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Inferior Segment ◽  
The Right ◽  
Proximal Occlusion

Simultaneous ST-segment elevation (SST-SE) in anterior and inferior leads in the setting of ST-segment elevation myocardial infarction is often confounding for a cardiologist and further more challenging is the angiographic localization of the culprit vessel. SST-SE can be fatal as it jeopardizes simultaneously a larger area of myocardium. This phenomenon could be due to “one lesion, one artery,” “two lesions, one artery,” “two lesions, two arteries,” or combinations in two different coronary arteries. We have discussed an index case where we encountered a phenomenon of SST-SE and coronary angiography demonstrated “two lesions, one artery” (proximal occlusion and distal critical diffuse stenoses of the wrap-around left anterior descending [LAD] artery) and “two lesions, two (different coronary) arteries” (previously mentioned stenoses of the LAD artery and critical stenosis of the posterolateral branch of the right coronary arteries). We have also described in brief the possible causes of this phenomena and their electroangiographic correlation of the culprit vessels.

scholarly journals Adherence to Guidelines for Cardiac Catheterization Referrals and Secondary Prevention Strategies in Patients with Non-ST Segment Elevation Acute Coronary Syndromes

1970 ◽  
Vol 9 (3) ◽  
Author(s):  
Michelle J. Haroun MD ◽  
Anjali Shroff MD, ◽  
Joshua J. Manolakos ◽  
Madhu K. Natarajan MD MSc ◽  
John You MD MSc, ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Cardiac Catheterization ◽  
Acute Coronary Syndromes ◽  
Wait Times ◽  
Prevention Strategies ◽  
Invasive Procedures ◽  
St Segment Elevation ◽  
Rehabilitation Programs ◽  
St Segment ◽  
Coronary Syndromes

Background: Previous studies have demonstrated higher referral rates for invasive procedures among patients admitted with acute coronary syndromes (ACS) to hospitals with catheterization facilities compared to those without. Studies have also reported underuse of evidence-based medical therapies and cardiac rehabilitation programs post myocardial infarction. We evaluated referral patterns for cardiac catheterization and use of secondary prevention strategies in current practice.Methods: We conducted a retrospective study of 397 patients with non-ST segment elevation ACS, comparing angiography referrals at a hospital with on-site catheterization facilities (Site A, n = 194) versus a hospital without (Site B, n = 203). We also recorded the use of secondary prevention strategies including discharge medications, referrals to smoking cessation programs and cardiac rehabilitation.Results: There was no significant effect of on-site angiography on the decision to manage patients invasively (adjusted OR for on-site angiography 1.49 95% CI 0.92-2.44, p = .11), or wait times for cardiac catheterization (Site A 1.9 days vs. Site B 2.2 days, difference −0.3 days, 95% CI −0.83 to 0.55, p = .70). However, at the time of hospital discharge, less than 70% of patients were prescribed dual antiplatelet therapy and only 13% of patients were referred for cardiac rehabilitation.Conclusion: These observations suggest that in contemporary practice in a Southern Ontario community, the availability of on-site percutaneous coronary intervention does not influence referral rates or wait times for cardiac catheterization. However we did observe significant underuse of cardiac rehabilitation programs and certain medical therapies. This suggests that despite improvements in access to invasive procedures, there remain important gaps in secondary prevention of coronary artery disease, which represent opportunities to improve quality of care in these patients.

463Temporal trends in latecomer ST-segment elevation myocardial infarction patients: Insights from the AMIS Plus Registry 1997–2017

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Roberto ◽  
D Radovanovic ◽  
L Biasco ◽  
A Quagliana ◽  
P Erne ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Temporal Trends ◽  
Late Presentation ◽  
Evidence Based ◽  
Absolute Rate ◽  
Pharmacological Treatments ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Introduction A relevant proportion of patients experiencing ST-segment elevation myocardial infarction (STEMI) has a late presentation after symptoms onset. Temporal trends deriving from a large real-word scenario for this subgroup of patients are lacking. Purpose The aim of the present study was to provide a comprehensive analysis of temporal trends in latecomer STEMI patients, with particular regard to implementation of evidence-based treatments in this population and major in-hospital outcomes. Methods All STEMI patients included in the AMIS Plus Registry from January 1997 to December 2017 were included and patient-related delay was assessed: 27 231 patients were available for the final analysis. STEMI patients were classified as early or latecomers according to patient-related delay (≤ or >12 hours, respectively). Results 22 928 patients were earlycomers (84%) and 4303 patients were classified as latecomers (16%). Across the study period we observed a significant decrease in prevalence of late presentation from 22% to 12.3% (p<0.001, Figure 1). In latecomer STEMI patients there was a gradual uptake of evidence-based pharmacological treatments with an increase in discharge prescription of P2Y12 inhibitors from 6% to 90.7% (p<0.001). Similarly, a marked increase in percutaneous coronary intervention (PCI) rate was observed (12.1–86.6%; p<0.001). Across this 20-year period, in-hospital mortality was reduced to a third (to an absolute rate of 4.5%, p<0.001) and a significant reduction in prevalence of both cardiogenic shock (14.6–4.3%) and re-infarction (5.4–0.2%) during the index hospitalisation was observed (p<0.001 for both variables). Length of hospitalisation in acute care facilities significantly decreased from 10 (6,14) days to 4 (1,7) days (p<0.001). At multivariate analysis, PCI had a strong independent protective effect toward in-hospital mortality (odds ratio 0.3, 95% confidence interval 0.187 to 0.480). Figure 1 Conclusion The present study provides a comprehensive picture of temporal trends in late presentation in STEMI over the last 20 years in Switzerland. During the study period in latecomer STEMI population there was a gradual uptake of evidence-based pharmacological treatments and a marked increase in PCI rate. In-hospital mortality was reduced to a third (to an absolute rate of 4.5%) and this reduction seems to be mainly associated with the increasing implementation of PCI.

Sign in / Sign up

Export Citation Format

Share Document